


In Confidence

by emmadelosnardos



Category: Sherlock (TV)
Genre: Addiction, Homophobia, M/M, Psychoanalysis, Psychological Trauma, psychiatric diagnosis
Language: English
Status: Completed
Published: 2012-03-20
Updated: 2012-08-26
Packaged: 2017-11-02 05:59:39
Rating: Mature
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 24
Words: 40,012
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/365708
Author URL: https://archiveofourown.org/users/emmadelosnardos/pseuds/emmadelosnardos
Summary: <blockquote class="userstuff">
              <p>Reason for referral: Patient was admitted to dual diagnosis unit for detox on 27.5.2002. BIB brother, Mycroft Holmes, following arrest for intoxication on 26.5.2002. Pt was under the influence of cocaine when he was admitted. Pt was admitted for 28 days with possible extension to two months. Requested single unit. Request granted by special permission of the Director.</p>
            </blockquote>





	1. Intake Interview with Patient SH

**Author's Note:**

  * For [roane](https://archiveofourown.org/users/roane/gifts).



**Patient** : Sherlock Holmes

 **DOB:** 19.7.1976

 **Date of admission:** 27.5.2002

 **Age:**  26

 **Reason for referral:**  Pt was admitted to dual diagnosis unit for detox on 27.5.2002. BIB brother, Mycroft Holmes, following arrest for intoxication on 26.5.2002. Pt was under the influence of cocaine when he was admitted. Pt was admitted for 28 days with possible extension to two months. Requested single unit. Request granted by special permission of the Director.

 **History:**  Pt is a 26-year-old, White university graduate who is currently unemployed. He does not have a fixed residence. Pt reported having received various psychiatric diagnoses in the past, including: bipolar disorder, conduct disorder, Asperger's disorder, histrionic personality disorder, antisocial personality disorder, and obsessive compulsive personality disorder. Pt is not taking rx. Pt does not currently have a PCP or a psychiatrist. Pt last saw psychiatrist in 1992. He said that he stopped therapy because "the doctor was an idiot." Pt reported some neurological symptoms and will be referred for a neuropsychological evaluation. Pt has no other reported medical conditions. Pt is allergic to shellfish and sulfa drugs.

Pt has a hx of cocaine inhalation and injection heroin use; began using substances in 1994 during university.  Pt also smokes cigarettes, approx. 1 pack/day. Denies current alcohol use. Displayed lack of insight into substance use; said that he was "not your usual addict." Pt is sexually active; pt said that his sexual orientation was "irrelevant" because he "uses protection and doesn't share needles." 

 **Mental status:**  Patient was oriented to place, person, time. Pt was hostile towards the examiner and refused to answer some questions. Pt appeared poorly related and did not adhere to social norms. Eye contact was intermittent and ranging. Pt reported that his mood was "bored". He displayed a limited range of affect. Speech was pressured and loquacious. Psychomotor agitation; pt paced during session. Thought content was focused on the reasons for the patient being in rehab. Thought processes were tangential and paranoid; pt reported that his brother "had set you [the examiner] up for this". Pt also evinced delusional thought processes and grandiosity; he claimed that he needed to leave the facility "in order to prevent a murder". Attention was inconsistent; pt was easily distracted by minor aspects of the examiner's appearance and the layout of the office. Pt's intellectual abilities are superior. Pt denied substance use in the last 10 days. Pt denied auditory/visual hallucinations. Denied suicidal/homicidal ideation. No evidence of malingering. Pt will return for his first therapy session tomorrow.

**Diagnosis:**

Axis I: 

Cocaine-Induced Psychotic Disorder, With Delusions [292.11] 

R/O Bipolar disorder, most recent episode hypomanic [296.40]

Axis II:

R/O Histrionic personality disorder [301.50]

Axis III:

Peripheral sensory neuropathy [337.1]

Allergies to shellfish, sulfa medications.

Axis IV:

Economic problems, housing problems, problems with primary support group, problems related to interaction with the legal system.

Axis V: 

Global Assessment of Functioning: 30. Behavior is considerably influenced by delusions. Inability to function in almost all areas. Some danger of hurting self or others.


	2. Developmental and Psychiatric History

Date: 28.5.2002, 11:00a.m.

Pt: Holmes, Sherlock

Psych Note:

Sherlock Holmes, a 25yo White man with a history of polysubstance abuse (cocaine and heroin) and a differential diagnosis of a mood disorder, was seen for 45min to continue the intake interview begun on 27.5.2002. The previous intake with Dr Northrup was discontinued due to the pt’s intoxicated state and uncooperativeness.

 _Mental status:_ Mr Holmes was taciturn and did not engage easily with the examiner. He was argumentative and stated that he did not wish to be at Blakely House. Speech was pressured. Pt described his mood as “morose.” In contrast to his behaviour with Dr Northrup, pt displayed little motor activity and spent the entirety of the session slumped in his chair with his eyes inappropriately fixated on the examiner. Pt appeared internally preoccupied but denied hallucinations. Thought content was focused on the pt’s developmental history. Pt’s thought processes were somewhat tangential. Pt persisted in his delusion that he is responsible for preventing a murder. No SI/HI. No AH/VH.

 _Session Notes:_ Mr Holmes arrived on time for his first appointment with Dr Carola Rivas, his psychologist. A developmental and psychiatric history was taken. See attached form for details. Pt appeared guarded and initially refused to supply information about himself. Five minutes were spent in silence before the pt demanded that the psychologist “deduce” his past. She provided some minor observations on his appearance and attitude, noting, for example, that his clothing and his accent denoted a privileged upbringing, which information he corroborated. He made some similar observations about the psychologist, at which point she explained that the purpose of the intake was not to gather information about the psychologist but rather about the patient. Pt responded poorly to her redirection, and requested to fill out the intake form himself “because I [he] could do a better job than the lot of you idiots.” This idiot responded that she would be the note-taker because she needed him to direct his full attention to the task. Appearing somewhat mollified, he assented to answer her questions. Pt spoke in a grandiloquent manner; e.g., when describing his Caesarean birth, stated that he had been “from his mother’s womb untimely ripped”. Pt frequently needed to be reminded to stay on task.

 _Progress towards goals:_ Mr Holmes appeared to make some progress in establishing a relationship with this examiner. He displayed less agitation at the end of the session. Pt reluctantly agreed to return to begin psychotherapy in two days, saying, “not much else to do around here and you still need to get your report.” The pt displayed evidence of a sense of humour, joking that he would present the psychologist with her own intake report at the next session.

 _Recommendations:_ Differential diagnosis: R/O autism spectrum disorder, R/O bipolar disorder; R/O obsessive-compulsive disorder. Treatment plan to be determined; minimum of three sessions of individual psychotherapy per week. Continuation of methadone maintenance is recommended. Pt to be referred for the following groups: Social Skills Building; Men’s Support Group; Drama and Music; Risk Reduction. Pt also eligible for career counselling and housing placement services.

Signed,

Carola Rivas, Ph.D.

Attending Psychologist

*****************************************************************

Page 2: Developmental History

Name: Holmes, Sherlock

DOB: 7/19/1976

Age: 25

Father: Holmes, Sigur Frederic (died when patient was 22, colon cancer). Served in Foreign and Commonwealth Office.

Mother: Holmes, Violeta Portnoy (died when patient was 12, car accident). Concert pianist.

Siblings: Holmes, Mycroft (31yo). Special Assistant to the Home Secretary.

Pregnancy and birth: Pt was born via Caesarean section after a full-term pregnancy. There were no complications during pregnancy or delivery. Mother did not consume alcohol, nicotine, or other substances during pregnancy. No significant illnesses in first year of life.

Developmental milestones: Pt met developmental milestones early. First words, 9mos. Sitting, 6mos. Crawling, 8mos. Walking, 9mos. Using sentences: 14 mos. Reading: 4yo. Toilet training (day and night) by 3yo.

Family environment: SH grew up with his mother, his father, and his brother (7 years older). Pt reported having had a “satisfactory” relationship with his mother. He refused to comment on his relationships with his father and brother despite prompting from the psychologist. Pt became agitated when talking about his family and threatened to discontinue the interview.

Education: Pt left home for public school at age 12. Pt reported receiving excellent grades in every level of school. Entered Cambridge at age 17 to read chemistry. Took a dual degree in biochemistry and music performance (violin). Pt displayed evidence of grandiosity when discussing his academic history; additional information is needed to corroborate his report of receiving a doctorate at age 22. Vocabulary and comprehension appeared to be in the superior range. Pt spontaneously demonstrated his skill in mental arithmetic by correctly multiplying five-digit numbers without the use of a calculator or paper/pen.

Employment: Pt is not currently employed. Pt is financially supported by his older brother. Pt was previously employed as a chemistry tutor at Cambridge, until 2001. Pt earned small sums of cash as a violinist until several months ago, when he withdrew from his position in a regional orchestra. When asked what his ideal job would be, SH responded “consulting detective”. May need help with reality testing, as he struggled to accept that stable employment was a desirable future outcome for him.

Substance Use: Pt reported that he began smoking cigarettes at age 12. He denied that there was an association between his early drug use and his mother’s accidental death around the same time. Beginning at age 16 and until he was 21yo, SH experimented infrequently (1-2 times for each substance) with cannabis, ecstasy, heroin, cocaine, and LSD. Pt began to use cocaine and heroin with greater frequency around age 21. Pt denied that there was an association between his increased drug use and his father’s hospitalization for cancer around that time. Insight was lacking into the association between major personal losses and his drug use.

Psychiatric History: There is a family history of mental illness. Paternal grandfather was reported to have “some kind of madness,” but pt could not specify. Mother was reported to have bouts of depression. Pt said that his father was an “alcoholic and philanderer”. He diagnosed his brother with several fictitious disorders (e.g., called him a “bastardus rex” with “pervasive scopophilia”). Pt reported having had psychotherapy from age 12-15 for “problems with peers.” When asked to describe these problems, SH showed the psychologist a cigarette burn on his arm made by a classmate. He described various other incidents where he was bullied or victimized in school. When asked why he was the target, he said, “People always hate what they do not understand.” Pt reported that he had been diagnosed with conduct disorder at age 12 but refuted the diagnosis, now and at the time. He denied having tortured or killed animals for pleasure as a child. He denied violence towards others as a child or adolescent, “except in self-defence.” Mr Holmes has memorized the criteria for various psychiatric disorders and stated that he did not currently meet enough of the criteria to qualify for bipolar disorder disorder, PTSD, or a personality disorder. When this examiner asked him what he thought would be the closest diagnosis, he said, “Mood Disorder NOS, perhaps Eating Disorder NOS.” He acknowledged feeling sometimes “as if life were worthless, it’s so boring” and he admitted to “going for days on end without eating.” He had somewhat delusional beliefs around food, stating that he “could not think while he was digesting.” Patient is 6 feet tall, weighs 10 stone, and has a BMI of 19.0, putting him close to “underweight” (<18.5).

Interaction with the legal system: Prior to his arrest for intoxication on 5/26/2002, Mr Holmes had one prior arrest for consumption of cocaine in 2000. He was held overnight and issued an ASBO.

Progress towards goals: No stated goals; treatment plan to be completed. Mr Holmes appeared to make some progress in establishing a relationship with this examiner. He displayed less agitation at the end of the session. Pt reluctantly agreed to return to begin psychotherapy in two days, saying, “not much else to do around here and you still need to get your report.” The pt displayed a sense of humour, joking that he would present the psychologist with her own intake report at the next session.

Recommendations: Differential diagnosis: R/O autism spectrum disorder, R/O bipolar disorder; R/O obsessive-compulsive disorder. Treatment plan to be determined; minimum of three sessions of individual psychotherapy per week. Continuation of methadone maintenance is recommended. Pt will be referred for nutritional counselling. Pt to be referred for the following groups: Social Skills Practice; Men’s Support Group; Drama and Music; Risk Reduction. Pt also eligible for career counselling and housing placement services.  

Signed,

Carola Rivas, Ph.D.

Attending Psychologist   

**Notes for the Chapter:**

> Terms:  
> SI/HI: suicidal ideation / homicidal ideation  
> AH/VH: auditory hallucinations / visual hallucinations  
> NOS: Not Otherwise Specified (given when a person doesn’t quite meet all of the requirements for a specific disorder)  
> ASBO: Anti-Social Behaviour Order. Charge for minor crimes in the United Kingdom that involve "conduct which caused or was likely to cause harm, harassment, alarm or distress.”  
> Scopophilia: “love of watching”, associated with voyeurism and the gaze of the camera. Imaginary disorder.
> 
> Author’s Note:  
> The interesting thing about writing this story in psychiatric note form is that not only do I have to write the note, but I have to imagine how the session went. And then I translate that into note form. It’s harder than it sounds, because there are a lot of interesting things that happen in a session that would never make it into the note. For example, we would expect Sherlock to “talk back” a lot more than we see him do here, but that kind of behaviour is reflected in terms like “uncooperative” and “argumentative,” etc., rather than in lots of dialogue taken straight from the session. Likewise, the therapist’s contributions rarely make it into a treatment note. Future chapters of this story will include some therapy transcripts as well as treatment notes, I have decided, in order to give a more balanced view of what happens to Sherlock at Blakely House.  
> If you have read my prior fanfic, Pax americana, you will notice that Sherlock’s past is largely based on the back history that I wrote for that story.  
> Also, I don’t have much experience treating drug users, and I’ve only worked in out-patient departments, not residential treatment facilities, so if you spot something that doesn’t sound right, please let me know. And shout out if you want to learn more about anything else. I’m happy to share.


	3. Therapy Session No. 1

**Summary for the Chapter:**

> Confidential.   
> For training purposes only.   
> Do not circulate.  
> Date: 29.5.2002 11a.m.  
> Psychologist: Dr Carola Rivas, PhD  
> Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS.   
> Session No. 1.

CR:      Good morning.

SH:      ….

CR:      ….

SH:      Are we just going to sit here? Aren’t you going to ask me more questions?

CR:      This is your time. We can use it however you want. Do you want me to ask you more questions?

SH:      No. I’m not going to tell you anything, anyway.

CR:      Yes, I knew that already.

SH:      You did not.

CR:      …..

SH:      Oh, I get it. You’re going to wait in silence until I talk.

CR:      It could be like that, yes.

SH:      But not if I don’t want it to be, right? That’s how it works?

CR:      You have been in therapy before, Mr Holmes.

SH:      Not since I was 15, thank you very much. I’d like to think that the technique has improved in the last ten years, but obviously, it hasn’t. Still harping on about what the patient wants, what the patient feels, when you overlook the most important fact of all!

CR:      Which is?

SH:      I don’t want to be here. I’m not like your other patients.

CR:      What do you think our other patients are like?

SH:      Which ones? Because I can tell you about the ones in my group this morning. Did you know that they actually sent me to a Social Skills group? Of course they don’t call it that, they call it something else, like “Conversation”, to not offend us, but I know that’s what it really was. Why does everyone think that I have no social skills? Just because I don’t use them doesn’t mean that I don’t have them. They put me in there with, oh, let’s see, where to begin. The man in the corner who rocked during the entire session and wouldn’t look anyone in the eye? Schizophrenic. Good luck teaching him skills. And then there was the woman who kept leaning forward so that the men across from her could look down her shirt. Borderline, I’d guess. And—

CR:      What about you?

SH:      What about me?

CR:      We’re not here to talk about them. We’re here to talk about you.

SH:      I thought you said that this was my session. That I could talk about anything I wanted to.

CR:      …..

SH:      Fine. Let’s talk about me, shall we? Shall we talk about the fact that I don’t want to be here? How’s that for a promising beginning? ‘Involuntary patient in mental asylum.’ As if there could ever be a voluntary patient, with the food that you serve here. And don’t let me get started on the bedding. When did you last buy sheets, during the Cold War? I’ve counted three new ingrown hairs on my hamstrings, since I arrived here.

CR:      I thought you didn’t eat.

SH:      I don’t sleep, either, but that doesn’t stop me from observing. Oh, and by the way—I brought you something.

CR:      Yes?

SH:      A _gift_ , in your parlance. Isn’t that supposed to be significant, for you psychoanalysts? The patient is bringing you a gift.

CR:      What is this?

SH:      Your intake form.

CR:      Mine?

SH:      I did one on you.

CR:      …..

SH:      …..

CR:      …...

SH:      What do you think?

CR:      What do you want me to say?

SH:      Was it right? Did I miss anything?

CR:      Is that important for you? To be right?

SH:      Oh, very clever. I see where you’re going with this. The line between your eyes gives you away. You’re annoyed with me. You’re trying to pretend you’re not, trying to put on that sympathetic-therapist face, but I can see the tension in the line of your jaw. You want me to admit that it’s important for me to be right.

CR:      You act as if I have an agenda.

SH:      You do. You want me to quit. You want to save me.

CR:      Do I?

SH:      Didn’t you read the report that I gave you? The part where it said that you entered the profession because of an alcoholic father and a depressed mother? You weren’t able to save them, either, so you chose a career where you thought you’d be able to save others. Too bad you are working with people who don’t want to be saved. Must do wonders for your self-esteem. Next time, I’d reconsider. Instead of working with addicts—all too prone to relapse, you know, plus they have the terrible tendency to talk the ears off of anyone who wants to listen—you might put your services where they are wanted. Agoraphobia. Sexual dysfunction. Obsessive-compulsive disorder. Insomnia. Treat the ones who want to get better, doctor, and you might be thanked, one day. That’s what you’re waiting for, aren’t you? To be thanked? To save someone? Is that your phantasy? That I’ll come in and say, ‘Today I want to stop being an addict?’ Because that won’t happen. And do you know why? Because you have to be an addict in the first place to stop being an addict. I am not an addict, therefore, I cannot stop being an addict. Simple logic.

CR:      Nothing is simple, Mr Holmes.

SH:      Yes, thank you for stating the obvious, Dr Freud. Tell me, are you a Freudian? Envious of my penis? Or Lacanian? As a narcissist, I like the idea of a mirror stage. Or do you prefer Melanie Klein? I always thought that, if I were in analysis, I’d prefer a Kleinian analyst. All of that aggression to deal with. Good breast, bad breast, the mouth that bites the breast that feeds it. Peachy. Aggression is so much interesting than sexuality, wouldn’t you agree? Then again, thwarted desire can lead to aggression. Which reminds me, as I’ve said to your superiors, and it is worth repeating here, for all I know, the murder that I could have prevented has already been committed, and here I am, WORTHLESS, absolutely worthless. My brain is going to wither and rot in this place. How long did you say until I can leave? Twenty-eight days? Who decided to use a lunar calendar?

CR:      I am surprised to hear you call yourself a narcissist.

SH:      Really, doctor? You can’t tell just from looking at me?

CR:      Narcissists usually like to talk about themselves. You don’t.

SH:      Boring. I already know about myself. It’s much more interesting to talk about you. Or about the murder that isn’t being solved, as we sit here discussing trivialities. Do you really want to have blood on your hands? Because that’s what is going to happen here. A man is going to murder his lover so that his lover doesn’t tell his wife—his male lover, I might add, which certainly puts an interesting twist to things—the tragedy of the married man who loves other men. So twentieth century. Why do you think he married that woman? No, I have a better question for you. Why do you think he is going to murder his own lover? There’s the Freudian bit. Is it because his lover is going to out him? Oh, stupid. Stupid. I didn’t tell you about it yet, did I? That was a different doctor, yes? Or did I mention it in the Drama group? They don’t have any musical instruments in the Drama and Music group. Mycroft said he’d bring my violin but he hasn’t come by yet. Do you know when he’s coming? If you talk to him before I do, can you ask him to bring the Cremona? I wouldn’t want to leave the Strad lying around here.

CR:      All phone calls have to go through the director’s office.

SH:      I am not going to call Mycroft. I want you to talk to him. I know he’ll call you to ask you about me. You can tell him then.

CR:      I don’t discuss my patients with people who aren’t staff here.

SH:      Ha! That’s a lie.

CR:      …

SH:      …

CR:      I don’t.

SH:      It doesn’t matter. He’ll find a way to talk to you. And when he does, ask him to bring the Cremona.

CR:      …

SH:      …

CR:      …

SH:      Oh, don’t be so predictable. Now you’re doing that therapist trick again. Staring at me, expecting me to reveal some early childhood trauma that you’ll tear apart with your superb analytical skills.

CR:      …

SH:      Tell me. I know you want to tell me something.

CR:      …

SH:      …

CR:      You are the second son in a family of brilliant people. Your older brother took after your father, going into public service, and you took after your mother, a musician. Your mother died when you were young, in essence abandoning you to your father and brother, who were always a pair, united in their similarity. You stood out. You weren’t like them. More sensitive. Easier to hurt, I’d say. And then, let’s see.

SH:      Go on.

CR:       Your father felt guilty for your mother’s death—in an automobile accident where he was driving.

SH:      Of course he felt guilty. He was drinking. He was responsible.

CR:      And you blamed him for her death.

SH:      I blamed him because he was responsible.

CR:      You were a reminder of your mother, and your father sent you away to school. In a foreign country, no less, where you didn’t even speak the language. You learned quickly, perhaps too quickly. Learned the naughty words first. Learned to defend yourself in any language. But there were wounds that words couldn’t prevent. Am I right? And then, coming home on holiday, you began to smoke cigarettes. To make him angry. Let me guess—was he an athlete? Did another relative have lung cancer? Or was it your resemblance to him that he hated, the fact that you were also looking to chemicals for solace?

SH:      A tennis player. He hated to see me light up. You can walk off a hangover. Lung cancer is more insidious.

CR:      Both of you had lost her. She must have been quite the woman. Your mother, his wife. And you couldn’t console each other. So you’d come home on holiday smelling of cigarettes. You were twelve, thirteen years old. What did your father do about it?

SH:      Made Mycroft steal my cigarettes and throw them in the pond. The first of many times.

CR:      So, your father set your brother up against you. And now your father is dead.

SH:      Obviously.

CR:      Did I get anything wrong?

SH:      Are you mocking me?

CR:      Not at all. But I’m afraid that time is almost up.

SR:      What?

CR:      I’m sorry, our time is up for today.

SH:      You can’t be serious.

CR:      Next time we can discuss your father in more depth. You’ll have some time to process things.

SH:      I don’t need time to process anything. There’s nothing to process.

CR:      Thanks for coming today.

SH:      It’s not like I had a choice, did I?

CR:      There’s always a choice.

SH:      What is that supposed to mean?

CR:      We’ll discuss it next time.

 

 

 

 

**Notes for the Chapter:**

> Thanks to Roane for reading along as I wrote this and giving me feedback and encouragement. If you like psychology and Sherlock, you should check out what she is doing with psychoanalytic defense mechanisms in her fic "Displacement" and its sequels.


	4. Session Notes

Date:   29.5.2002 9a.m.

Psychologists: Dr Geoffrey Mallow, Dr Jemima Hall

Psych Note: Sherlock Holmes, a 25yo White man with a history of cocaine abuse and symptoms of major depressive disorder, attended a 40-minute Social Skills Building group with five other patients. Mr Holmes arrived late to the group. He said that he was feeling “perfectly wretched” and complained of withdrawal symptoms (headache, stomach-ache, fatigue). He chose a chair in the corner of the room and was asked to move into the circle, which he did reluctantly. SH did not spontaneously initiate conversation or comment on other members’ statements unless prompted to do so. He provoked a violent reaction from one member of the group (LM) when he made an unkind observation about her. One therapist and a group member (TT) physically restrained LM after she swung her fist at SH, narrowly missing his face. The group was dismissed 20 minutes early. It is recommended that the patient not return for this group.

Signed,

Geoffrey Mallow, Ph.D.

Post-Doctoral Fellow in Psychology

 __________________________________________________________

Date:   29.5.2002 11a.m.

Psychologist: Dr Carola Rivas

Psych Note: Sherlock Holmes, a 25yo man with a history of heroin and cocaine abuse, was seen for 45 minutes of individual psychotherapy. The pt arrived 10 minutes late to his session. He was flushed and appeared to be suffering withdrawal symptoms. The pt displayed some hostility towards the therapist. For example, he brought her an “intake form” that he wrote based on what he had observed of her the day before. He attempted to intimidate her by displaying his knowledge of psychoanalysis. SH stated that he did not want to be at Blakely House and complained about the Social Skills group. His speech was pressured, yet fluent and coherent, displaying a sharp wit and keen sense of irony. Pt said that he needed to prevent a murder, giving details of the case. He requested that the therapist speak to his brother to have his violin brought to Blakely. The pt became more engaged towards the end of the session, when the therapist made a few observations about the psychodynamics of his family. Pt is of superior intelligence and has the potential to function at a much higher level than he is currently at.

Recommendations: Continue with individual psychotherapy. Grant patient telephone access so that he can call his brother. Write treatment plan with patient’s cooperation. 

Signed,

Carola Rivas, Ph.D.

Attending Psychologist

 __________________________________________________________

Date:   30.5.2002 2p.m.

Psychiatrist: Dr Mariah Franklin

Psych Note: Sherlock Holmes, a 25yo old man with a history of heroin and cocaine abuse, was seen for 30 minutes for a psychopharm consultation. Pt was polite and cooperative. He was succinct, yet thorough, in providing answers. Pt appeared to be highly knowledgeable about psychopharmacology and neuroscience.

SH was not taking prescription medication prior to admission on 27.5.2002. He was admitted while intoxicated with cocaine. Pt reported using cocaine on a weekly basis “to get high” and used low doses of heroin on an almost daily basis. Pt has been using both substances for approximately three years. Pt abstained for six months in 2000 but relapsed following graduation from university. Pt said that “the problem was not the drugs, the problem is boredom.” Pt expressed an interest in methadone maintenance therapy. Pt strongly objected to anticonvulsant and antidepressant medications; mood symptoms will be addressed again at a later date.

Pt complained of flu-like symptoms, including diarrhea, sweating, muscle pains, and increased sensitivity to pain. Pt reported extreme fatigue and noted that he overslept this morning and noted that he does not usually sleep more than four hrs/night. Pt reported that he gets pleasure “from playing music” and appeared distressed that his violin had not been delivered to him. He also reported being interested in “organic chemistry, forensic anthropology, murder, and poisons,” though his ironic tone of voice suggested that he was deliberately misleading this writer.

SH took an initial dose of 30mg of methadone under the psychiatrist’s supervision. Pt will be monitored by nursing staff to determine if there are adverse effects. Titration up to 100mg/d recommended in next week.

It is recommended that his psychotherapist work with SH to address his mood symptoms and to determine whether they preceded his drug use. Pt will return tomorrow to receive his next dose of methadone.

Signed,

Mariah Franklin, MB BChir, MRCP

Attending Psychiatrist

**Notes for the Chapter:**

> Please note that I'm being trained in clinical psychology, not psychiatry, so any mistakes in the psychiatric note are due to my own ignorance.


	5. Session No. 2

**Notes for the Chapter:**

> I encourage you to read some of the readers' comments and my responses if you are curious about clinical psychology, because I have answered some questions in a lot of detail here. And in case you're curious, I have posted the complete poems that Sherlock cites at my tumblr, emmadelosnardos.tumblr.com. I've been posting snippets and previews there about this story, and my other stories, so check that out if you are interested. Emma
> 
> P.S. My sincerest thanks to Roane for always being willing to read a rough draft of whatever I'm working on.

Treatment Plan – Draft

Patient: Holmes, Sherlock

Date: 30.5.2002

 **Background:** SH is a 25yo White male university graduate. He was admitted to dual diagnosis unit at Blakely House for detox on 27.5.2002. BIB brother, Mycroft Holmes, following arrest for intoxication on 26.5.2002. Pt was under the influence of cocaine when he was admitted. Pt began methadone maintenance on 29.5.2002.

**Diagnosis:**

Axis I: Cocaine Withdrawal, Opioid Withdrawal [292.0]; R/O Bipolar disorder, most recent episode hypomanic [296.40]; R/O Asperger's Disorder [299.80]

Axis II: Diagnosis Deferred

Axis III: Peripheral sensory neuropathy [337.1]; Allergies to shellfish, sulfa medications.

Axis IV: Economic problems, housing problems, problems with primary support group, problems related to interaction with the legal system.

Axis V: Global Assessment of Functioning: 40. Major impairment in multiple areas: social, occupational, family. Some danger of hurting self or others.

**4-week Treatment Plan**

Goal 1: Pt will reduce dependence on heroin and cocaine.

Objectives:

Pt will adhere to methadone maintenance therapy as directed by his psychiatrist.

Pt will identify triggers for substance use.

Pt will create sobriety plan for after discharge.

Pt will attend scheduled appointments following discharge.

Goal 2: Pt will report fewer mood symptoms.

Objectives:

Pt will use words to describe his mood state.

Pt will use psychotherapy to discuss the impact of his family life on his mood.

Pt will identify activities that bring him pleasure.

Pt will engage in pleasurable activities on a daily basis.

Goal 3: Staff will report improved social functioning of SH at Blakely House.

Objectives:

Pt will attend Social Skills Group and adhere to group rules.

Pt will obey Blakely House rules regarding behaviour towards others.

Pt will use psychotherapy to talk about social and family relationships.

* * *

Session Note

_Confidential. For training purposes only. Do not circulate._

Date: 30.5.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 2.

SH: …

CR: …

SH Is this what we're doing? Again?

CR: What are we doing?

SH: You sit there and wait for me to say something.

CR: Yes. Yes, that's part of what we'll do. But today there's something we need to work on together. I've prepared a treatment plan for your stay here. I'd like you to read it so that we can discuss it together. And then we both need to sign it.

SH: …

CR: …

SH: …

CR: ….

SH: Ha!

CR: What's that?

SH: I'm not 'in danger of hurting self or others.' You have got that wrong. Why did you write this? I told you that I wasn't suicidal. And I am not violent.

CR: Perhaps you can tell me what happened in the group yesterday. I was told that you upset another group member.

SH: I deduced the number of suicide attempts that she had made. Turns out I was correct.

CR: And?

SH: She tried to attack _me_. I didn't hurt _her._

CR: Hmm. Why do you think she attacked you?

SH: I said she _tried_ to attack me. They restrained her.

CR: Of course. But, returning to my question, why do you think she wanted to attack you?

SH: Because she has borderline personality disorder. Does there need to be a reason?

CR: Well, frankly, I'm worried about you. I don't like the idea of you being attacked by others while you are at Blakely.

SH: Then don't make me go to group therapy. They don't want me back, anyway.

CR: How convenient.

SH: What are you implying?

CR: That you caused a scene in order to get kicked out of the group. Which I can certainly understand. But I keep coming back to the idea of you being attacked while you're here. That would be very unfortunate.

SH: I am not going to be attacked! And if I were, I can certainly fend for myself. I know martial arts.

CR: And I'm thinking, should we write instead, "Pt in danger of being attacked by other patients"?

SH: Don't write anything. Forget it. Just take out that sentence about me being a danger to self or others.

CR: We could post a security guard outside of your room. Would that help?

SH: There's someone outside of my room all the time anyway. Comes in and checks on me every fifteen minutes. Wants to make sure I don't off myself. Do you know, there are at least five ways that a patient here could kill himself, even with all of the safeguards you have in place?

CR: And why does that interest you?

SH: I'm just saying, for a place that sees a lot of very disturbed individuals—I know what kinds of people are here—you aren't taking the necessary precautions.

CR: I'm listening.

SH: There's a man in 6A who has a belt. His wife brought it in with some clothes, didn't realize it was still in his trousers. He's saving it. You had better look into that.

CR: Thank you. I will. Anything else?

SH: I'll make you a list and bring it tomorrow.

CR: Thank you. But we won't meet again until Friday.

SH: Friday, then. Do you think anyone will do themselves in before then?

CR: Are you suggesting that we meet earlier?

SH: Certainly not. Just that—I wouldn't want—do you have a mailbox? Somewhere to leave the list for you?

CR: You can leave it under my door.

SH: Excellent. Will give me something to do.

CR: Anything else that you'd like to comment on about the treatment plan?

SH: I'm surprised that it took you this long to come up with the Asperger's rule-out. I must be getting better with the social interactions.

CR: I read from Dr Northrup's note that you've been given that diagnosis before. Why didn't you mention it when I asked you what you thought would be the most appropriate diagnosis for you?

SH: And do your job for you?

CR: You were testing me.

SH: Obviously. You're not the only one who is making observations around here, _Doctor._

CR: And what do you observe?

SH: Like I said before, you went into this field because of a misguided desire to help others.

CR: Not very specific to me, I'm afraid. Nearly everyone who does what I do—

SH: -has a saviour complex?

CR: Something like that. Again, we're talking about me, not you.

SH: Very observant you are.

CR: …

SH: I'll sign it. Formalities. Paper work. Tedious. Can we move on?

CR: Of course.

SH: Mycroft is bringing my violin tomorrow.

CR: Which one? The Cremona?

SH: Ah, very good. You remembered. The Cremona, yes.

CR: What else should I know about you and music?

SH: Depends on how interested you are in the violin.

CR: …

SH: You won't tell me, but I'd guess that you play. Or you wouldn't remember something like the name of a luthier. And of course you won't tell me one way or another if you play or not. Those are the rules, right? And I'm here to follow the rules. That's what my treatment plan says. So I won't ask you. But I'll tell you, instead. I'd been working on the Sibelius violin concerto. Which, if you don't already know, is a very challenging piece.

CR: Do you like it?

SH: What do you mean?

CR: What do you like about the piece? Why this piece? Why Sibelius? Did you choose it?

SH: I choose all of my pieces. I'm the soloist.

CR: …

SH: I've a bit of thing for Sibelius, those folk melodies here and there, in what is otherwise a pretty standard orchestral tone poem. And the first movement, I like the gradual rise of the semiquavers, almost Bachian in how the bow alternates between the La and Mi strings, until the melody surges to something high and strange. It's difficult to play, even for me. But I was a bit bored with the Mendelssohn. And I'm not feeling particularly keen on Ludwig or Wolfgang at the moment. Wanted something more modern, less tonal. The conductor was game, so we were on.

CR: What is going to happen now?

SH: Now what?

CR: Now that you're here.

SH: That's not the problem.

CR: Is there a problem? Or are you saying that it's fine that you're here? Because I would have thought that a month without the concertino, well, it might put a damper on rehearsal.

SH: If you would let me finish, you would already know how this was going to end.

CR: …

SH: I can't play now.

CR: …

SH: …

CR: …

SH: Go on, ask me. I know you want to know.

CR: What do you mean you can't play? Did something happen?

SH: I don't know. No, that's not true. I'll try to stick to the truth. I think I know what happened. And I just need Dr Franklin to confirm a few things for me. Then I'll know for sure.

CR: I still don't understand.

SH: No, you wouldn't, would you? Peripheral neuropathy. Common side effect of sustained cocaine use. I think even _you_ should know that. Numbness of fingers, loss of sensation, loss of control of fine motor movements. Tell me, doctor, what use is a violinist who can't feel his fingers? Who thinks he's moved into third position but has overshot to fourth? Whose vibrato is scattered and inconsistent? I might as well be last chair of the second violins. My brain knows what to do, but my body won't obey me.

CR: I can't imagine what that must feel like.

SH: Don't bother. I can tell you. It feels – it feels – I suppose you want me to say that it feels like a betrayal? I might say that, if I had ever felt so attached to my body in the first place. But it's transport. It's all transport. These bones, this face, this trick which you see _,_ " _es cadáver, es polvo, es sombra, es nada_." I _knew_ that. I always knew that. And yet—I wanted a little longer. I thought I'd have more time.

CR: More time for what?

SH: To play. To burn the candle at both ends. It makes a lovely light, my friend. Or are you my foe?

CR: You speak Spanish. You recite poetry.

SH: How observant you are.

CR: May I ask how you learned?

SH: Learned what? Afraid there's no time to discuss _castellano_ or Millay today. Time's up. The 50-minute hour. Am I right?

CR: …

SH: …

CR: You'll tell me more about the poem next time.

SH: Which one?

CR: The Spanish one.

SH: How do you know it's a poem?

CR: Meter, Mr. Holmes.

SH: Very observant, Dr Rivas. And I see you can count.

**Notes for the Chapter:**

> I've had a few requests for information about training in the field of clinical psychology. I don't know how it works in other countries, but in the United States there are various ways that one can become a psychotherapist (psychiatrist, clinical psychologist, social worker, counsellor, etc. – all can do psychotherapy). My degree will be a Ph.D. in clinical psychology, which prepares me to practice psychotherapy, administer psychological and neuropsychological tests (think Rorschach and IQ tests, respectively), and conduct research on mental illness and therapy. Psychiatrists are medical doctors that prescribe psychotropic medications. I will not be able to prescribe meds, but I do work closely with psychiatrists as part of my training, so it's important for me to understand something of psychopharmacology.
> 
> I am in the fourth year of my (hopefully six-year) Ph.D. I have completed my coursework and departmental exams and am now at the point where my days are spent teaching undergraduates, working on my dissertation, and seeing patients at a city hospital. Beginning in my second year, I have spent 16-20 hours per week working at various clinics and hospitals in New York City as part of my clinical training. This is how we learn to become psychologists, through actually conducting therapy and administering psychological exams, and writing session notes and case reports (whence comes my knowledge of the genre). I love it all. The field is varied enough to keep my interest, and specific enough to allow me to specialize. My particular interests are in neuropsychology; multicultural/multilingual therapy; child psychology; and bipolar disorder.
> 
> I think I will write a longer post later on tumblr if there is any interest in hearing more about clinical psychology, or about how I came to the field, because I didn't study psychology as an undergraduate at college, and it was something that I came to rather later.
> 
> ~Emma


	6. Session No. 3

**Notes for the Chapter:**

> As always, I find that the more emotional a fic gets, the more time it takes me to write. So that is what explains my delay in publishing this chapter.
> 
> Roane has been just an invaluable beta and friend throughout the writing of this. We originally connected because of her own series, "Defense Mechanisms," which also has a psychological theme to it. I hope you check it out if you have not already.
> 
> Thank you for the feedback and comments so far. It means a lot to me to have so many enthusiastic readers!
> 
> Emma

In Confidence

_Confidential. For training purposes only. Do not circulate._

Date:   31.5.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 3.

 

SH:      May I lie on your couch?

CR:      If you like.

SH:      I would.

CR:      …

SH:      …

CR:      How does it feel?

SH:      Although I cannot see you, I am certain that you can observe that my feet are dangling off the edge.

CR:      Would you like to sit up again?

SH:      It doesn’t bother me. But, as I am well within one standard deviation of the mean height of British males under 40, I would hope that the manufacturers would take that into account when fabricating sofas for psychoanalytic purposes. Unless, of course, the average analytic patient is female?

CR:      …

SH:      Does your silence mean that I haven’t said anything of interest yet? Because if that’s what you’re waiting for, I can supply.

CR:      …

SH:      I see I have to do all the work here. Some therapy…

CR:      …

SH:      Mycroft brought the Cremona. He wanted to stay for visiting hours but I didn’t invite him. That’s one good thing about this place, the visiting policy. It’s like prison, isn’t it? I can’t get a visitor unless I invite him.

CR:      Yes.

SH:      Yes, as in yes, I _can_ get uninvited visitors, or yes, as in yes, I can’t get a visitor unless I invite him?

CR:      There are no uninvited visitors.

SH:      Good. As I said, that appears to be a sound policy. So. He brought my violin but the fool forgot to bring the stand. Fortunately I had tucked the sheet music inside the case, otherwise I’m certain he would have forgotten that, as well. But without a music stand I’ve had to make do with posting the music on the walls of my bedroom. It’s a damned nuisance because the tape they’ve given me from the craft room has absolutely no staying power. And no one will give me so much as a thumb tack! It’s ridiculous. Though I do have to admit, there are probably at least three ways that someone could kill himself with a thumb tack, none of them among the more painless ways to die. But I digress. Or not? You did say that this was free association. I can say whatever comes into my head, whatever appears on the screen before my closed eyes. So perhaps I should tell you about how I learned to play the violin? Would you like to hear that story?

CR:      Yes. It seems very important to you.

SH:      Ha! Very observant, Sigmund. Yes, violin is important. It’s almost _imperative,_ I would say. Imperative. Consequential. Irreplaceable. Non-negotiable. That’s why Mycroft brought the instrument. He knew that I’d pull a jailbreak if I didn’t have the violin here. The _ennui, ma chérie…_ there’s nothing to _do_ here. There’s no one to talk to, besides you, because everyone else tries to tell me that I should believe in a higher power and all that twelve-step shite. Higher power! _Music_ is the higher power. And don’t tell me that it’s all right to be an atheist, that it’s all well and good to choose music as my saving grace. I don’t want to be saved. I don’t want to make amends. Who has made amends to _me?_ I don’t want to live day by day. Tiger, tiger, burning bright. I want to _burn_ in the forest of the night _._ Conflagration, _incendio,_ out with a bang. Not with a whimper, whatever the poet thought of the matter. A bang is how I’ll go out. Preferably young; Rimbaud, 37. Mozart, 35. All geniuses die young. Even Jesus. And before you write a note about grandiosity, doctor, remind yourself that I _am_ a genius. If anyone has a reason to be grandiose, a genius does. Surely even you can admit that. And don’t ask me to surrender. I’ve already surrendered to music, as well as anyone can in this day and age, when there are other things to do, but none as absolutely _imperative_ as the music. Nothing like –

CR:      Something you said. Can we return to it? About others not making amends to you. Who might you want to make amends to you?

SH:      You can’t figure that out yourself? Then you’re a bigger idiot than I took you for.

CR:      My making a guess is nowhere near as interesting to me as hearing what you have to say. The limits of deduction, to use a favourite word of yours.

SH:      Indeed. The limits of deduction. Amends, amends. To make amends. To free from wrong. How can we ever _free someone from wrong?_ The deed, once committed, is done.

CR:      Are you thinking of any deed in particular?

SH:      Must you persist in being so obtuse?

CR:      …

SH:      My mother’s death.

CR:      …

SH:      I’m sitting up now. The couch itches.

CR:      And you can’t see my face.

SH:      What does that have to do with anything?

CR:      Sometimes, when people are talking about something that is especially difficult, or moving, they feel alone when they can’t see the therapist’s face.

SH:      I told you, the couch is itchy. Poor grade of wool. Musty, too. Dear God, I hope you have someone in to clean this from time to time.

CR:      Your mother’s death.

SH:      You don’t let go of an idea easily, do you?

CR:      When do _you_ , Mr Holmes? Let go of an idea easily?

SH:      Never.

CR:      And you think that I should?

SH:      Yes. But you haven’t -- exactly -- you haven’t exactly met -- my...

CR:      …

SH:      My mother’s death, you are supposed to say. Prompt me to keep talking about it. As if I could forget it.

CR:      No, I imagine you wouldn’t be able to forget it.

SH:      And haven’t I tried! Wouldn’t _you_ , if you were the one to answer the phone in the middle of the night? -- not Mycroft, he was at a mate’s house; not Nanny, she was asleep. I answered the phone, and that was the year when my voice broke, and I answered, _thick with sleep_ , I always think of it like that--that I was _thick with sleep_ \--I _hate_ sleep, I don’t know why I would remember that detail, in that way. You tell me, doctor: why do we remember our lives in phrases, images, songs? Why did that night distill down to that one moment, the fact that I was sleepy and dull-headed, and why do I always remember it like that? Thick. Dull. Obtuse. Idiot. Asleep.

CR:      You answered the telephone.

SH:      Yes. I was the one who answered the call.

CR:      And then?

SH:      Then what? What more could I do? They thought I was Mycroft. And it still was a lark, then, to play at being Mycroft. The officer -- he thought I was older. He told me to come down to the station.

CR:      …

SH:      ...

CR:      And?

SH:      And what?

CR:      What did you do?

SH:      I went to the station.

CR:      By yourself?

SH:      We were in London at the time. Staying at the townhouse. I took a cab. They wouldn’t let me in when I arrived, they thought it was some mistake.

CR:      It _was_ a mistake.

SH:      Yes. And they wouldn’t--wouldn’t let me in to see the body, it had already been identified, of course, Sigur was already there to do that.

CR:      Sigur?

SH:      My father.

CR:      Yes, I remembered his name.

SH:      Then why did you ask?

CR:      In case there was another Sigur. Most people don’t refer to their parents by their given names.

SH:      I am not most people.

CR:      …

SH:      Was that even important, your question? I think not. I call him ‘Sigur’ because that was his name.

CR:      ...

SH:      Sigur was at the station, in a holding cell. I snuck in and found him; they had already taken my mother elsewhere, to the morgue at St Bart’s. She died instantly. Broken spinal cord, Sigur said later, instant death. No pain. As if that was what I was worried about, whether or not my mother had been in pain _. I_ suffered with her death; she did not.

CR:      What do you mean, you found your father? In a holding cell?

SH:      He was driving. He had been drinking. Of course they held him for questioning. Nearly ruined his career, too. At least, it ruined his chance at a seat in Parliament. He had hereditary rights but had decided to forgo them and sit for election in the Commons. He withdrew his candidacy after that. It was in all the papers: my mother’s death, my father’s involvement, his withdrawal from elections. Everything.

CR:      Was he charged with anything?

SH:      No.

CR:      Why not?

SH:      Do you know who my father was?

CR:      Tell me.

SH:      A peer. A fucking viscount. Employed by SIS. ‘Essential to the nation’s security.’ No, he was not charged. I am disturbed that I would have to explain this to you.

CR:      So, you found him there in the station, in a cell? What did you say to him?

SH:      Nothing. He didn’t see me. He never knew that I was there. I left and went back home. Went back to sleep. Only I couldn’t sleep, not that night, and not the following. I couldn’t sleep for nearly a week. I’ve never been much of a sleeper, anyway. Sleep is boring.

CR:      I imagine it wasn’t boredom that kept you awake.

SH:      No, it wasn’t boredom. But that’s what keeps me awake, generally. As an adult, I mean. Do you know, I have slept more here than I have in years? I cannot fathom why. I’m bored stiff and I am sleeping half the day. Most uncommon.

CR:      Methadone. It’s an opioid, you know. Makes you relax. And you don’t have the cocaine to keep you up.

SH:      Believe me, if there was any cocaine in this place, I’d have it. And there’s not. So--sleep. Yes, I am sleeping.

CR:      And you could not sleep after you found out about your mother’s death.

SH:      A common response to shock, anxiety, distress, trauma. Insomnia. Hypertension. Indigestion. Yes. Does it surprise you that, after her death, I had a trauma response? Or does it surprise you even more that I’m aware of it? That I know what was going on?

CR:      I am not surprised at all. Why?

SH:      I’ve been told that I’m not good with emotions.

CR:      That doesn’t mean that you don’t understand them. On an intellectual level, that is.

SH:      I understand everything on an intellectual level. What is that supposed to mean? On what other level _can_ one understand the world?

CR:      You speak of the past, you speak of trauma, and there is no emotion in your voice.

SH:      …

CR:      …

SH:      Did you want me to cry?

CR:      I don’t _want_ anything of you. We’re here to talk. Well, you talk. And I listen, mostly. I listen very, very well. Surely you’ve noticed that by now. With your observational skills being what they are.

SH:      Are you mocking me?

CR:      And what if I am? Haven’t you mocked me, here?

SH:      But _you’re_ the therapist! You’re supposed to be kind, and accepting, and show me unconditional positive regard! That’s your job!

CR:      While I can tell that you have familiarized yourself with the work of Carl Rogers, that really doesn’t impress me. You talk the talk, Sherlock. You can identify your own defenses, list the reasons behind your actions, deduce the other’s emotions. But can you _feel_ your own? It’s easier to name than to feel, it’s simpler to deduce than to wait for the answer to unfold.

SH:      Is that what we’re doing here? Waiting for the answer to unfold?

CR:      Now you’re starting to understand.

SH:      So, once I start to _feel_ my emotions, then I can go?

CR:      Go where?

SH:      Leave Blakely House. Where else did you think I meant?

CR:      The session is almost over. And I don’t hold patients hostage until they understand their feelings.

SH:      Then what about involuntary commitment?

CR:      You made your choice.

SH:      I did. And I didn’t choose to come here.

CR:      …

SH:      …

CR:      I’m not holding you hostage. To me or to your feelings. You can leave at any time.

SH:      You persist in speaking lies.

CR:      That’s a bit harsh, even for you. One: You have not been involuntarily committed, however you may understand the situation. Or misunderstand the situation. Two: You are not mentally incompetent. Three: You have the right to a lawyer. You have the right to leave. But you haven’t, yet. Which makes me think: some part of you wants to be here. Despite your protests, despite your blaming your brother. You, Sherlock Holmes--there’s a part of you that really wants to be here. And that’s the part that we’re going to work with. That we _have_ been working with. That part of you that wants to change.

SH:      Are we done here? Can I go?

CR:      Yes.

SH:      …

CR:      Goodbye.

SH:      For now.

 

 

 


	7. Official correspondence

**Notes for the Chapter:**

> Sorry for the slow update here, but a major dissertation deadline is looming for me and I was hard-pressed to find writing time for that this week, much less my fictional works. 
> 
> I am so thrilled with the intelligent questions that all of you have been asking me about psychiatry and psychology! If I haven't responded yet it's because I've been wrapped up with schoolwork.
> 
> ~Emma
> 
> P.S. Thanks Roane for the beta work!

On Fri, 31 May 2002 at 9:16, Detective Sgt Lestrade <glestrade@met.police.uk> wrote:

Dear Sir or Madam:

I am writing to request permission to speak with one of the patients at Blakely House. My name is Gregory Lestrade and I work for the Homicide and Serious Crimes Command of the Metropolitan Police of London. We believe that your patient, Sherlock Holmes, may have information that can aid us in solving a homicide.

I understand that Blakely House is a residential facility and that your patients have limited contact with people outside of the facility while they are in treatment. At your earliest convenience, I would like to schedule an appointment with Mr Holmes during visiting hours. Please let me know your procedures for meeting with patients.

If you have any additional questions, please feel free to contact me in the meanwhile.

Yours,

**Detective Sergeant Gregory Lestrade  
Metropolitan Police of London  
Homicide and Serious Crimes Command  
Specialist Casework Investigations Team**  
<glestrade@met.police.uk>

* * *

On Fri, 31 May 2002 at 9:47, Dr Mariah Franklin <director@blakely.org.uk> wrote:

Sgt Lestrade:

Thank you for contacting us. I regret to inform you that all visitors to Blakely House must be invited by the patients themselves. The exception, of course, is if a patient is wanted for a crime, in which case a warrant must be presented and we will arrange for the patient to be transferred to a secure psychiatric facility. Do you have a warrant for Mr Holmes? Without a warrant, I am afraid that the patient must request your visit. I cannot provide any additional information at this time.

How did you come to know that Mr Holmes was at our facility? That is confidential information.

Sincerely,

**Dr Mariah Franklin, MB BChir, MRCP  
Director and Attending Psychiatrist  
Blakely House  
Surrey RH1**  
<director@blakely.org.uk>

This message and any attachments are confidential and intended solely  
for the use of the individual or entity to which they are addressed. If  
you are not the intended recipient, you are prohibited from printing,  
copying, forwarding, saving, or otherwise using or relying upon them in  
any manner. Please notify the sender immediately if you have received  
this message by mistake and delete it from your system.

* * *

On Fri, 31 May 2002 at 9:50, Detective Sgt Lestrade <glestrade@met.police.uk> wrote:

Dr Franklin:

Thank you for your prompt response. Mycroft Holmes informed me that I could find his brother at Blakely House. Sherlock Holmes is not a suspect for any crime and therefore I do not have a warrant. Could you pass a message to him on my behalf? He knows who I am and I believe that he would be willing to speak to me.

Please let me know how to proceed.

Sincerely,

**Detective Sergeant Gregory Lestrade  
Metropolitan Police of London  
Homicide and Serious Crimes Command  
Specialist Casework Investigations Team**  
<glestrade@met.police.uk>

* * *

On Fri, 31 May 2002 at 14:56, Detective Sgt Lestrade <glestrade@met.police.uk> wrote:

Pete:

She says I have to go through security procedures to see Sherlock. See attached message.

Can you believe this? I told you we should have just shown up there with our stripes.

And I have to get to Redhill at 9am on a Sunday. I better be getting overtime for this. And don't forget the petrol money this time.

Greg

 

\- Forwarded message -  
From: **Dr Mariah Franklin** <director@blakely.org.uk>  
Date: Fri, 31 May 2002 at 14:52  
Subject: Re: Met Police: request to speak with Blakely pt  
To: Detective Sgt Lestrade <glestrade@met.police.uk>

Sgt Lestrade:

The patient has been informed that you wish to speak to him. He has consented to meet with you during the next visiting hours, at 9am on Sunday, 2 June 2002. Please present yourself to the Blakely House Main Office at 8:30am on that date for security procedures.

Cheers,

**Dr Mariah Franklin, MB BChir, MRCP  
Director and Attending Psychiatrist  
Blakely House  
Surrey RH1**  
<director@blakely.org.uk>

This message and any attachments are confidential and intended solely  
for the use of the individual or entity to which they are addressed. If  
you are not the intended recipient, you are prohibited from printing,  
copying, forwarding, saving, or otherwise using or relying upon them in  
any manner. Please notify the sender immediately if you have received  
this message by mistake and delete it from your system.

* * *

On Fri, 31 May 2002 at 15:01, Commander Gibbons <fpgibbons@met.police.uk> wrote:

Greg:

You did want to clear some cold cases. Go speak to Sherlock.

Mermaid's Chest tonight? Trivia bowl, remember?

~FPG

**Temporary Commander F. Peter Gibbons**

**Metropolitan Police of London  
Homicide and Serious Crimes Command  
Specialist Casework Investigations Team**

<fpgibbons@met.police.uk>

* * *

On Fri, 31 May 2002 at 15:08, Detective Sgt Lestrade <glestrade@met.police.uk> wrote:

Who's going to be there?

If I could bring Sherlock, we'd clear the house.

~G

**Detective Sergeant Gregory Lestrade  
Metropolitan Police of London  
Homicide and Serious Crimes Command  
Specialist Casework Investigations Team**  
<glestrade@met.police.uk>

* * *

On Fri, 31 May 2002 at 15:15, Commander Gibbons <fpgibbons@met.police.uk> wrote:

Greg:

Your informant is staying in the madhouse in Surrey. Ask Dimmock if he wants to come instead.

Anyway, Holmes doesn't know Fulham from QPR. He wouldn't be much use there. It's sports night, remember?

~FPG

**Temporary Commander F. Peter Gibbons**

**Metropolitan Police of London  
Homicide and Serious Crimes Command  
Specialist Casework Investigations Team**

<fpgibbons@met.police.uk>

* * *

On Fri, 31 May 2002 at 15:35, Sgt Lestrade <glestrade@met.police.uk> wrote:

Dr Franklin:

Please inform your patient that I will meet with him on Sunday, 2 June 2002.

Thank you for your assistance in this matter.

Best,

**Detective Sergeant Gregory Lestrade  
Metropolitan Police of London  
Homicide and Serious Crimes Command  
Specialist Casework Investigations Team**  
<glestrade@met.police.uk>

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	8. Official correspondence

From: **Dr Mariah Franklin** <director@blakely.org.uk>  
Date: Fri, 31 May 2002 at 15:02  
Subject: Re: Met Police: request to speak with Blakely pt  
Fwd: **Carola Rivas** <rivas@blakely.org.uk>:  
  


Carola:

See email below. Someone from the met police wants to talk to SH. I spoke with SH and he approved the visit. Detective Lestrade will be coming on Sunday during visiting hours.  
I know you already met with SH today, but I'll be interested to hear what he tells you on Monday.

Did SH also tell you that he needed to leave Blakely so that he could prevent a murder? It seems that he may have been telling the truth. Reminds me of that patient who kept telling us that she had had a love child by a Tory MP (you know who) and it turned out she wasn't delusional, after all.

In any case, it sounds like quite a complicated mess. Any idea how or why SH has contacts at Scotland Yard? Did he report any legal involvement before being arrested for intoxication last week?

I'll follow up in another email about LM.

~Mariah

On Fri, 31 May 2002 at 9:16, **Detective Sgt Lestrade**.uk wrote:

...

* * *

From: **Carola Rivas** <rivas@blakely.org.uk>

Date: Fri, 31 May 2002 at 16:02  
Subject: SH  
To: **Dr Mariah Franklin** <director@blakely.org.uk>  
  
  


Mariah,

Thanks for notifying me re: police visit to SH. To my knowledge, his only police involvement was the arrest last week. Will verify this with him on Monday.

I think I prefer the idea of a delusional SH to a rational SH, if the rational one means that he could have prevented a murder but didn't, because he was here instead.

Is that awful of me to say? I can't quite figure out what a better outcome would look like.

Pub w/ Geoff and me? 6pm?

~CR

* * *

From: **Dr Mariah Franklin** <director@blakely.org.uk>  
Date: Fri, 31 May 2002 at 16:16  
Subject: Re: SH  
To: **Carola Rivas** <rivas@blakely.org.uk>:  
  


Carola:

If it's awful to prefer having a delusional patient to knowing that someone was murdered, then I'm right there with you. J

Besides, we don't know when the person was murdered. All the detective said was that he is coming to talk to SH about something related to a homicide. For all we know it could have happened months ago.

Following up about LM: She has requested a discharge at the end of next week. Said she couldn't concentrate on her treatment as long as SH was at Blakely. Complained that he stared at her and "gave her the willies", etc. Threatened to sue us for negligence, again. I'm referring her to Maudsley. Revolving door patient, indeed. How many referrals has it been, now?

6pm at the Mermaid's Trunk? I could use a stiff one after this week…

-Mariah

* * *

From: **Carola Rivas** <rivas@blakely.org.uk>Date: Fri, 31 May 2002 at 16:32  
Subject: LM  
To: **Dr Mariah Franklin** <director@blakely.org.uk>  
  


Mariah,

I've referred LM twice to Maudsley, Geoff has referred her once, and I think Macdougall referred her to Bethlem before I was here.

I'll let you know more about SH after I meet with him again on Monday. He's quite the talker.

~CR

* * *

From: **Detective Sgt Lestrade** <glestrade@met.police.uk> wrote:  
Date: Sun, 2 Jun 2002 at 12:10  
Subject: our favourite informant  
To: **Commander Gibbons** <fpgibbons@met.police.uk>  
  


Pete:

Met with Sherlock this morning. I can't believe that I gave up my weekend to spend my time getting insulted by a junkie in rehab. Makes me almost wish that we hadn't arrested him. I know I said he needed help, but I'm a detective, not a social worker.

Turns out Sherlock thought we would have solved the Horne murder by now; he'd totally written it off as far as he was concerned. Wasn't interested in talking about it until after he told me about the other case I mentioned on the phone. You did send a patrol around to the address I told you? Sherlock wouldn't sit down until he knew that something was being done about Teddy Gordon's rentboy lover. So please tell me that the bloke has got some protection and we won't find another dead body tomorrow.

Of course, after I heard about how stupid we all are, _then_ he wanted to tell me all about the Horne case. I had to listen to him crow about it for 20 minutes, just because we didn't notice that a new tree had been planted in David Horne's yard. So now we'll have to order an exhumation. Just what I want to do bright and early on a Monday morning.

And don't forget that you owe us a round, after Friday's trivia rout.

Greg  
 **Detective Sergeant Gregory Lestrade**  
 **Metropolitan Police of London**  
 **Homicide and Serious Crimes Command**  
 **Specialist Casework Investigations Team**  
glestrade@met.police.uk

* * *

From: **Commander Gibbons** <fpgibbons@met.police.uk>  
Date: Mon, 3 Jun 2002 at 9:10  
Subject: Re: our favourite informant  
To: **Detective Sgt Lestrade** <glestrade@met.police.uk> 

 

Greg:

You solved a cold case and probably prevented another. Rentboy Charles is in a safehouse, and Teddy Gordon is being held for questioning and attempted murder. Constable Roberts apprehended him with a weapon in in Charles' flat. You are lucky that you met with Sherlock when you did. A few minutes later, and we would have had another murder.

So – not _too_ upset, are you? You're a detective. You solve cases. And you solved two yesterday. Well done, Greg. We'll talk more later today after the exhumation. I doubt there'll be any problems.

And - tomorrow you can have off. That's an order, Sergeant.

~FPG

**Temporary Commander F. Peter Gibbons**   
**Metropolitan Police of London**   
**Homicide and Serious Crimes Command**   
**Specialist Casework Investigations Team**


	9. Session No. 4

**Notes for the Chapter:**

> Thank you to Roane for helping to beta this chapter (and the others). It makes such a difference to have a critical eye look over these things.

_Confidential. For training purposes only. Do not circulate._

 

Date:   3.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 4.

 

****************** 

 

SH:      Did Dr Franklin tell you that I had a visitor?

CR:      Yes. Would you like to tell me about it?

SH:      Obviously.

CR:      …

SH:      You’re supposed to ask me who it was.

CR:      But you know that I already know who it was.

SH:      Yes, but this is what they teach in the social skills group. It’s more polite to ask someone a question than to assume that you know the answer. Even though I know the answer.

CR:      Now I’m confused. Are you saying that I should pretend that I don’t know who came to see you? Even though we both know that I talk with other clinicians here? Weren’t you going to tell me about your visitor? The detective?

SH:      Ah-hah! You _did_ know. Yes, Scotland Yard detective. Came to see me about a murder – not the one I was telling you about earlier, mind you, but I think he’ll take care of that one too. See that it doesn’t happen, I mean. No, he came to see me about a case that has been open for two or three months now. I thought I’d left a real trail for them to follow but apparently it wasn’t enough to lead the horse to the water. Did you catch that, doctor? I used metaphorical language.

CR:      And?

SH:      It demonstrates that I understand metaphors. Symbolism. Imaginative variation. Something that autists aren’t supposed to do.

CR:      So now you’re calling yourself an autist?

SH:      I’ve never used that term to describe myself. It’s what others have said. Derisively, I might add.

CR:      …

SH:      Detective Lestrade came. Acted like he’d never seen the inside of a loony bin before. The way he looked around before he took a seat. Told me you looked through his pockets, too. Not you, personally, Doctor Rivas. _I_ for one liked the idea of the police getting the pat-down. Would you do the same to my brother, I wonder, if he were to pay a call? And could I watch? That _would_ be a motivator. I’d have him in right away, in that case.

CR:      Aren’t you going to tell me about the murders? Or were those not important?

SH:      Important? Hardly. Run-of-the-mill homicides. Nothing to write home about. If I were the type to write home, I mean. Strange, I’ve hardly seen a pencil around here. Or pens for that matter. Are you afraid that we’re going to poke our eyes out? Like Oedipus? Now, that _would_ make an impression on your little Freudian brains, now wouldn’t it?

CR:      I fail to see the relevance.

SH:      Relevance? I’m telling you what comes into my head. _You’re_ supposed to make sense of it, doctor, not me.

CR:      Do you imagine that I’m _not_ ‘making sense’ of this?

SH:      Your work is tedious. Boring for you, and even more so for me. I already know what you’ll say.

CR:      Which is?

SH:      That I’m trying to compensate for a childhood spent under the shadow of an older, more competent brother. That I blame myself, wrongly (you suppose), for my mother’s death. That I hated my father. That I believe that my mother’s death was punishment for my hatred of my father.

CR:      You _have_ been reading Freud, I see.

SH:      Dull, really. Formulaic. The Greek myths all over again. And told much less elegantly.

CR:      I agree.

SH:      Do you really, now? Now, _there’s_ an opinion from you, at last.

CR:      It’s lacking meaning when you parse it down like that. But – have you read his case studies on hysteria?

SH:      What?

CR:      Have you read Freud’s _Studies on Hysteria_?

SH:      No.

CR:      You might find them amusing. I know for a fact that the patient library has a copy.

SH:      Perhaps, if I’m feeling at a loss for something to do…

CR:      Because you’re obviously feeling _so_ entertained around here.

SH:      Sarcasm is the lowest form of humour.

CR:      …

SH:      I find things to do. Solving old murders, for one. Now, _that_ is a productive pastime. Oh, there I go again! _Productivity._ Is that how you measure your worth? Mycroft would say so. Always a Calvinist, Mycroft was, like our father. I was the Roman one. Pagan, even. Must be why I like confession. And the Dionysian rites. He, on the other hand, is the more sanctimonious one. He practically _drips_ with sanctimoniousness.

CR:      How did he come to be the one to bring you in?

SH:      Mycroft? I called him.

CR:      You called him? Wait – I don’t understand.

SH:      It’s very simple. I called him. Asked him to bring me.

CR:      But – but – _why_?

SH:      I know you are an idiot, but can you _please_ refrain from making that expression with your mouth? It’s most unflattering and gives you the appearance of a goldfish. Now, as I was saying, I called Mycroft to bring me in because I knew that it would annoy him.

CR:      …

SH:      That expression really isn’t doing anything better to your face. Yes, I made him bring me in. I deliberately wanted to annoy him. Am I not supposed to admit to that? Is that a conclusion I’m supposed to come to only after years of analysis? Because I know my own motives. Which were—

CR:      To annoy your brother. That’s why you’re here.

SH:      No, that’s not _why_ I’m here. You didn’t listen carefully. You _must_ listen carefully in this profession or you’ll be rubbish. I said he was the one to bring me in. But I would have come anyway. He was just the means.

CR:      You would have come? By yourself?

SH:      Yes. I would have come anyway. Does that surprise you?

CR:      Frankly, yes.

SH:      I’ll give you another five seconds to get over your shock and close your mouth. Now, as I was saying, Mycroft brought me in, but that’s only because I knew that he was meeting with the Russian ambassador that day, and I thought it would be a bit of a lark to make him have to come down to London to rescue me from myself. I just _wish_ I could have heard what kind of excuse he made to the ambassador. But I wasn’t supposed to know about that meeting, so I wasn’t going to flat-out _ask_ him how that went.

CR:      Let me make sure I understand. You were going to come here anyway, but you asked Mycroft to bring you in because you wanted to make a nuisance of yourself?

SH:      Now she understands. _Yes,_ that’s exactly why.

CR:      Let me ask you another question. Why did you want to come here?

SH:      Isn’t that obvious?

CR:      I can think of any number of reasons why you might want to be here, but I might be wrong. Perhaps you can tell me.

SH:      To stop using. Isn’t that why people get into rehab?

CR:      I’m not interested in ‘people,’ Sherlock. I’m interested in _you._

SH:      Ah, I see. Individual data, not central tendencies. N of one, etc. Throw out everything you previously knew. Descartes? I’m a bit more Bayesian, to tell you the truth. I’d rather base my conclusions on all the previous evidence available, not to mention what I know about others in a similar situation. Revise as I go. Discard improbable solutions. Reformulate my hypothesis. Hypothesis, test, revise hypothesis, test again. So, tell me: what do you know about others in my situation?

CR:      It’s interesting to me that you seem to not want to talk about yourself. That you talk _around_ yourself.

SH:      I have no problem talking about myself. Isn’t that what I’m doing here? Talking about me, me, me? All the livelong day. Sherlock in the morning, social skills group. Sherlock at midday, therapy. Sherlock in the afternoon, drama and music. Sherlock in the evening. Me, me, me. I get bored of it all.

CR:      I’m not bored. Quite the contrary. I want to hear more about Sherlock Holmes. Which is why I’m sorry that we have to end soon.

SH:      Always that sad old trick, eh? Just when things are heating up, you end the session.

CR:      Or one might say that, just when the session is drawing to a close, you come up with the most interesting things to say. Almost as if you bring them up now so that we can’t talk about them at length. Because you know we’re ending soon.

SH:      Harrumph. What was the interesting thing that I said just now?

CR:      That you want to be here. That you want to quit using. That it was your choice to come.

SH:      Yes. It was. Are you satisfied?

CR:      Far from it. I want to hear more.

SH:      …

CR:      So we’ll see each other on Wednesday?

SH:      Not like I have anywhere else to be.

CR:      Until then.

SH:      Good-bye.

**Notes for the Chapter:**

> I have had such fun interacting with some of you on tumblr and talking about Sherlock and psychopathology! I've created a page on my tumblr account where I've compiled the mini-essays that I've written there on Sherlock and psychopathology: http://emmadelosnardos.tumblr.com/critanalysis


	10. Session No. 5

**Notes for the Chapter:**

> Warning: Some mention of traumatic events in this chapter. And homophobia.

Session Note  
 _Confidential. For training purposes only. Do not circulate._  
Date: 5.6.2002 11a.m.  
Psychologist: Dr Carola Rivas, PhD  
Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 5.

* * *

 

* * *

CR:    Something you said last time – about wanting to be here.

SH:    I said that?

CR:    What I was wondering was – why did you have to get yourself arrested? In order to come here, I mean.

SH:    I would have thought that much was obvious.

CR:    No, not quite.

SH:    …

CR:    Please tell me.

SH:    He wouldn’t have come.

CR:    He wouldn’t have come?

SH:    Otherwise. He wouldn’t have come otherwise. He didn’t before. Not when—

CR:    What else don’t I know? About you? And your brother.

SH:    What do you want me to say? Do I have to say it? Honestly, doctor, I –

CR:    Say what?

SH:    Any number of things!

CR:    …

SH:    …

CR:    What – what is so difficult? About saying those things?

SH:    Can’t you see? It means admitting –

CR:    …

SH:     – that I –

CR:    …

SH:    – that I – I want something.

CR:    What do you want, Sherlock?

SH:    I want _everything._  I want it _all,_ and I will never be enough, never have enough, never _know_ enough. There’s too much I want, I can’t –

CR:    …

SH:    …

CR:    You can’t bear it.

SH:    I can’t bear it. Right. The not-having.

CR:    Of what are we speaking, exactly?

SH:    How far back must we go? I have to start earlier, start with my childhood. So clichéd, but that’s where it begins. The golden years? I wish that they were not, _had_ not been quite so sparkling and brilliant. I wish that I had never had such times, such…Did I tell you? The summers in Spain? I thought I’d mentioned Abu—my nanny, _abuela_ in Spanish. We went to Seville every year to stay with Abu. My mother’s mother.

CR:    What are the tears for?

SH:    Sod the tears! The tears – I can’t – I don’t know – I can’t say –

CR:    …

SH:    …

CR:    You are quite moved. Something has touched you, in what you just told me now. I wish I knew what it was. Can you – can you try to put it into words?

SH:    …

CR:    Can you try to say, what it was? What it was that made you cry?

SH:    I was never supposed to be like _this._ To be here. When _I_ had those summers – _I_ had them. Those months of Sarasate and Pergolesi and the bougainvillea in the garden. The nights that smelled like jasmine and spikenard. _He_ – Mycroft – was so much older, so often away. Spain was mine. It was me and Mummy and Abu, and her beautiful house. There was a pool, a shallow reflecting pool, with a fountain. Statues of satyrs and nymphs, some overblown baroque nonsense. That was my grandmother’s Andalusian patio. The Moorish influence, you know. Shut the family up – the women, they meant – inside the walls of the great _casona._ The walls were beautiful though— _beautiful prisons? not to me_ —lined with blue-and-white tiles, and the sound of the water echoed off the tiles. Especially at night, when I would steal out of my room and wander out. I was fascinated by the patio and the archways that lined that space, the lush greens of the plants, the insects I might discover underneath. And the frogs _¡Las ranas!_ The noise of the frogs at night. The outdoors come indoors -- that was Spain. In London they didn’t let me outdoors after dark, but in Seville – free rein of the patios, of the moonlit fountain, the fawns, the night.

CR:    It sounds very idyllic.

SH:    Paradisiacal, in fact. Or even further back. Lost, pagan gods.

CR:    …

SH:    There was one night that I have tried _not_ to remember. Put it away until I went to university and had reason to think about it again.

CR:    …

SH:    There was a _jardinero_ – sorry, a gardener. And he had a son, a year older than I was, but he was short and dark, and I have always been tall and pale. A ghost, a _fantasma,_ they liked to call me in Andalusia. Blame my father, those pale Vikings of York.

CR:    And the other boy? What was he like?

SH:    Have you read Lorca? The poet?

CR:    Tell me.

SH:    _Verde que te quiero verde._ I read that later, in secondary school – Heidelberg, not Edinburgh yet. Abu sent me his _Romancero._ And I thought of Manolo, but I _could not_ think of Manolo. Do you understand? The thinking of him and _not_ thinking of him, at once. The having and the not-having.

CR:    Manolo?

SH:    Manolo. My – friend? The gardener’s son. I’m not even sure that he would remember me, all these years later. But I remember him, one of those green nights by the fountain. I went out, to collect moths or night-beetles – quite the budding entomologist, I was. And he – Manolo – was in the fountain. Not so unusual. And he was naked. Again, not so unusual. Children in Spain aren’t told to cover up the way they are in England. The heat lends itself to nudity.

CR:    What happened?

SH:    I joined him. Surely even you could guess where the story was headed, tell _that_ much about me.

CR:    Tell what?

SH:    What I am. _Homosexual._ I didn’t know it, then, didn’t know that there was a word for who I was or what I was feeling, or even that it was different from what others were feelings. I found out soon enough.

CR:    That you like men?

SH:    That I _love_ men. Love being the crucial difference. Desire. I loved Manolo, I _wanted_ Manolo. _Verde que te quiero verde._ I didn’t have the words for it until later, when I read the poem about the bandit in the hills and girl pleading for her lover’s life, and there was something in that story, something of forbidden love.

CR:    You were how old?

SH:    Twelve. Does that sound too young to you? Too young to know what one wants?

CR:     I don’t have a particular age in mind, for desire. But I wanted to understand when this was. Before your mother died? Or after?

SH:    She died six months later.

CR:    …

SH:    Lorca was a homosexual, you know. A _marica,_ as they said in Andalusia. What was I saying?

CR:    Manolo. Your friend. You loved him.

SH:    I desired him, yes, without the words for it.

CR:    One does not always have the words for what we long for.

SH:    ...

CR:    Desire is constantly in retreat, at the edge of our awareness.

SH:    So you say. Fascinating. Yes, it was at the edge of my awareness. I can say that much, now, now that I know what drove me out to the fountain, when I hoped he would be there. We met for several nights –

CR:    Yes?

SH:    We met – that was all. Like friends, like boys do. We swam in the fountain. We had done as much the year before, and before that. He couldn’t say my name, called me ‘Saulo.’

CR:    Saulo?

SH:    It sounded the closest to Sherlock. Saulo and Manolo. We met that night, and he asked me to show him – to touch –

CR:    ...

SH:    ...

CR:    Yes. Did you want to?

SH:    I am not quite sure of what I wanted. Sounds strange to admit that, now, when I feel like the wanting never leaves me. But even today, when I look back on it, I am not sure I knew what I was or if I was copying Manolo. Because I liked him so much, I might have done anything he suggested.

CR:    Anything? Would you have let him touch you, if you didn’t want that?

SH:    I don’t know. I’m curious, you see. I like to find things out. I might have let him, even so. But – hypotheticals aside. He wanted to see me, see mine, see whose was longer, larger --. I’d played this game before, in school, but this wasn’t a changing room full of boys or a dare. It was just Manolo and I –

CR:    …

SH:    …

CR:    Go on.

SH:    I can’t. I’m sorry.

CR:    What brought the tears, this time?

SH:    It _was_ a beautiful thing! It _was –_ and then he had to go and spoil it. And I _wish_ –do you know what I would do to have that memory intact? To only remember that night, and the green water, and the sight of Manolo’s body, now running away, now coming closer? What I would do if that were the _only_ thing that I remembered of that night?

CR:    Whatever – whatever happened next – do you think that you would remember that night so clearly if things had not been broken?

SH:    If what had not been broken?

CR:    Your innocence. Your trust in yourself, in Manolo, in – in Mycroft? Was it Mycroft who discovered you?

SH:    Yes. Well-deduced, doctor.

CR:    You may call me Carola.

SH:    Carola. Yes. Mycroft found us. But not before – not before – we weren’t just naked together, you see. And Manolo wasn’t so very much older than I; certainly not so much older that they could blame him for what happened. Yes, Mycroft found us, _in flagrante coitus._ Well, not coitus exactly—it would be some time still before I learned how _that_ was worked out between two men—and it wasn’t even apparent to me at the time that that was what we were doing.

CR:    Are you embarrassed to tell me what it was? What exactly you were doing, I mean?

SH:    The third night. I sucked his cock.

CR:    Is that how you thought of it?

SH:    As cock-sucking? No, to tell you the truth, the phrase that comes to mind is _comiéndole la verga,_ if I had even put words to it, then. But cock-sucking it is, in English. Do I offend you with my language?

CR:    …

SH:    I take that as a ‘no.’

CR:    Your language is interesting. Not offensive to _me,_ but it _is_ offensive, in general. Judgmental. Hateful. ‘Sucking cock.’ _Cocksucker_. An insult. Definitely _not_ an endearment, though I think you were describing an act of love. Made ugly with those words.

SH:    Yes.

CR:    Who called you that? _Did_ someone call you that?

SH:    Of course. Who _didn’t_ call me that? That might be a better question. Yes, I was called --. By who else than Mycroft. He was the first. Then my father, just once. That first time, when he found out. Before my mother knew what had happened. She would have stopped him.

CR:    You didn’t mention that Mycroft was there. Is he much older than you are?

SH:    Seven years. He was in university, too busy with summer employment, practica, those kinds of things. Good for the vita. Made it to Spain for just a week. I didn’t know he was coming, and neither did Mummy. Just the kind of ‘surprise’ he liked to throw on us. And then I’d have to go around pretending that I was _thrilled_ to see my darling brother. Even before this -- even before what happened with Manolo, he was not -- _not welcome there._ Not by me. And I think Abu disliked him, just a little bit, for all that he had the right manners, and knew the right kind of people. He wasn’t like her, or like me. If he had been, if he had had _any_ sense of decency, he would have spoken to me before telling Father what he saw.

CR:    So he was the one who told your father. And then your father called you --

SH:    A cocksucker. Correct. And factually, he _was_ correct. I was a twelve-year-old cocksucker.

CR:    Still so judgmental.

SH:    Mycroft came to visit first, then Father. Mycroft saw us -- I still don’t know how, I don’t know when. But he saw us, and when my father came, he told him. They were always together. Like I was always with Abu and Mummy. A house divided.

CR:    Returning to something you said in the beginning. That you _wanted_ something from Mycroft. What did you want from him? To keep your secret?

SH:    That would be just the beginning. But, dear doctor -- _Carola_ \-- I am afraid that our time is up. Is it not?

CR:    …

SH:    Is it?

CR:    It is. I’ll see you on Friday.

SH:    Thank you.

**Notes for the Chapter:**

> Thanks to Roane for the quick beta job!
> 
> I was reminded of one of the earliest poems that I ever read in Spanish, Lorca's Romance Sonámbulo, by a conversation with aderyn about her fic. So, thank you to aderyn, for bringing Lorca to the forefront of my mind. This is the Andalusian chapter, after all. And Lorca had to have a place here.
> 
> For more on (my) Sherlock's Spanish roots, see my other story, "Pax americana."


	11. Session No. 6

Session Note

_Confidential. For training purposes only. Do not circulate._

Date: Friday, 7.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 6.

__________________________________

CR: Good morning.

SH: ...

CR: I haven't thanked you for the list that you left me.

SH: Oh, that.

CR: Yes,  _that._ The list of possible hazards for patients here. It was very-thorough.

SH: Did anything come of it?

CR: I passed it along to the director.

SH: Dr Franklin?

CR: Yes, Dr Franklin.

SH: My psychiatrist. I am meeting with her later today.

CR: Yes? Anything I should know about?

SH: I'm sure it hasn't escaped your notice that I've been in a wretched mood.

CR: After Wednesday-

SH: It was better on Wednesday. But over the weekend, when Lestrade-the detective-came.

CR: What were you feeling?

SH: My symptoms? The usual: fatigue, listlessness. I don't  _feel_ anything. The most overwhelming sense of tediousness.  _Ennui._ Can't be bothered to do anything. If there were anything to  _do_  around here.

CR: Textbook case of cocaine withdrawal. You know that, don't you?

SH: What?

CR: That you're describing what all the literature says about cocaine withdrawal. Some people find it helpful to know that there's a typical course, that it says more about the drug and what it's doing to their bodies than about who they are. Exhaustion - have you been sleeping more than usual?

SH: Yes.

CR: Increase in appetite?

SH: Unfortunately. The food here is less than appetising, I can tell you that much.

CR: Anhedonia? Meaning-

SH: ' _Lack of ability to feel pleasure_.' I know the term. Yes-.  _No._

CR: No? No to pleasure? No to anhedonia?

SH: We were-talking. Wednesday. About Manolo. And Mycroft.

CR: Yes.

SH: I felt desire then. Not  _sexual_  desire-I'm afraid I have to disappoint Dr Freud-but the wanting of  _something_.

CR: Yes. You started off by saying that you felt that there was no end to your wanting.

SH: Immense. Irretractable. I wouldn't say  _infinite,_ that's hyperbolic. But yes. The wanting of more.

CR: What is the 'more'? What do you want?

SH: What  _don't_ I want?  _Quiero. Quiero. Quiero_. In Spanish, the same word means 'to want' and 'to love.' Loving and wanting are merged. To want is to love, to love is to want something, someone. I want another green Sevillian night, without everything that followed. That much you could have guessed. I want-I want to play Bach again. Hang Sibelius-I don't care for Sibelius nearly as much as Bach, Schubert, Beethoven. Give me the baroques and the romantics. I want to play again.

CR: And your violin-isn't it here now?

SH: The violin is not the problem.  _I_ am the problem. My hands, to be precise, are the problem. Peripheral sensory neuropathy, as it says on my treatment plan. Translation: tingling, numbness in my fingers. It hasn't gone away, even without the cocaine these last few weeks.

CR: So you can't play.

SH: Precisely. Why else do you think I'd be here?

CR: I'm sorry?

SH: Why else do you think I'd be in therapy? Did you imagine that I  _like_  to talk about traumatic childhood events? That I  _like_ being locked up in here with the loonies? And I'm not talking about the patients, either. Then there are the ridiculous rules. The paucity of reading material. The absurdly transparent goals of the therapy groups.

CR: When you put it like that, I'm surprised  _anyone_ consents to being here.

SH: You said it, not I.

CR: So what are we going to do now?

SH: I've told you about my childhood-well, about the most singular event of my childhood. And now: can we get to work at cleaning out the abscess? Draining the wound? Because I don't like leaving things open like this. They will start to fester.

CR: You speak as if you had a physical wound. And in metaphor.

SH: Don't I? Have a physical wound, I mean. I thought we had already established that I know how to use metaphors. In any case,  _Anatomy is destiny,_ as Freud was wont to say. I've been reading about him. You planted his books in the library. I saw that.

CR: …

SH: As I was saying. So. My dopaminergic system is shot, to that I can attest. I know what coke does. And my serotonergic pathways? Forget it. I've downregulated those synapses, too. Not to mention the heroin. Stripped dry my opioid receptors; what to do about the pain, then? The lack of pleasure? I'm like a man who can't get it up, neurologically speaking. Now the trouble is I can't fire those damn action potentials without a large shock to the system. A shock that, if I'm not careful, will overload my synapses, set into action an undesirable cardiovascular event. Vasoconstriction. Infarct. Death by suffocation. I know what I risk if I use again. Especially after - after remission. So I'll risk the boredom. The ennui. Wait until homeostasis is restored.

CR: You sound pretty determined.

SH: But I'm an addict. So I wouldn't wonder if you doubt what I'm saying.

CR: You are an addict who knows the biochemistry of addiction.

SH: Of course I do. I have a doctorate in organic chemistry. That's not grandiosity, either; you can ask Mycroft.

CR: I already have.

SH: …

CR: Not recently. I'd tell you beforehand if I had reason to speak to him.

SH: Is there any addict who  _doesn't_ know the biochemistry of addiction? Who doesn't know exactly how much drug to take to get the desired effect? Who can't measure the seconds, minutes, hours to the next high in the level of his distress? You don't need a doctorate to know that.

CR: No, you don't.

SH: So why point out that I have one? What does that  _matter?_ What does it matter that I'm a genius? When I'm just the same as any other addict, in the end.

CR: Are you?

SH: I thought I wasn't. I hated all of that Narcos Anonymous drivel. Yes, I'll admit that I'm an addict. Not hard to admit to. I know I'm experiencing chemical dependency. I've become sensitized to my drug of choice-cocaine, I mean, heroin was always a complement to it, but cocaine is what I crave-and I need increasingly higher doses to get the same high. My functioning is disrupted; can't play the bloody violin. Otherwise I wouldn't be here.

CR: ...

SH: But I'm here, and I'm clearly an addict. Fit the definition to a tee. But so what? I'm also a violinist. A chemist. An Englishman. A homosexual. A member of the aristocracy. Any number of ways to identify myself. Why focus on the 'addict'? At least, that's what I thought, until the 'addict' started getting in the way of all the other things.

CR: …

SH: Why won't you  _say_ anything?

CR: What would you like me to say?

SH: Say  _something._ Anything. Just don't cock your head like that and imagine that I don't know that you're bored.

CR: I assure you, I am not bored.

SH: No? You've yawned twice in the last minute.

CR: I'm thinking. Something you said before; how you wanted to get on with the business of draining the abscess?

SH: Yes. Physical pain as a metaphor for psychic pain. Though, with what we know about biochemistry, we can't entirely separate the two, now can we? Physical pain  _is_ psychic pain. Emotions are carried in our neurotransmitters; our sentiments shape our brains, our bodies. Isn't that it? So - I used metaphor, yes. But more importantly: I want to get on with this.

CR: You want to be cured.

SH: Obviously.

CR: Psychotherapy is not surgery, Sherlock.

SH: …

CR: But it's admirable - your desire to change.

SH: Oh, shut it! I don't want your pity.

CR: Is this pity, then? My admiration?

SH: Superfluous flattery. I don't want that. I want you to see me for what I  _am._ I don't shrink from it, so why should you?

CR: And what are you? What part of me do you want me to see?

SH: The miserable addict.

CR: What else?

SH: …

CR: I've been thinking about something. The way you say that you're ' _a_ homosexual.' Not 'homosexual.' Not 'gay'. Not like it just happens to be a trait of yours, like saying 'I'm English' or 'I'm gay.' I've been wondering-

SH: -At the quaint anachronism?

CR: Is that what makes it sound unusual? I can't quite put my finger on it. But-by saying that you're  _a_ homosexual, it sounds as if you belong to a particular class of people. An undesirable class, at that.

SH: Are you telling me that homosexuality should be  _desirable,_ now?

CR: You look as if you expect me to recoil from you, every time you call yourself ' _a_ homo' -

SH: Not recoil.

CR: What, then?

SH: ...

CR: Did you want to shock me with it, then? Show me the worst - what  _you_  believe is the worst of yourself - from the get-go?

SH: There's no point in sugar-coating the facts.

CR: The facts being...?

SH: Who I am. What I am.

CR: And why would that shock me?

SH: Maybe it wouldn't shock you. You work with addicts. You know what we're like. God knows  _why_ you want to work with people like us. Maybe the same reason I'm curious about dead bodies: you can tell something about a person by the damage that has been done to him.

CR: As if every addict were the same. As if every body were the same. They're not, you know. And we need people to be interested in both: in the damaged brains and the dead bodies.

SH: Damn it! You  _want_ me to be good, is that it?

CR: …

SH: You want me to be admirable? I'm  _not_  admirable. I'm selfish, and I'm moody, and I don't get along well with others. You don't want to know what I do for kicks, whom I'll sleep with. You don't want to know.

CR: I  _do_  want to know. But-

SH: Time's up?

CR: Not quite.

SH: ...

CR: I want to know - what is so terrible about my showing admiration for you?

SH: It's not  _terrible_. It's just - it's not  _right_. It's a lie. I'm not like that. I'm not good.

CR: All right. I'll grant you that. You're not  _good._ But-can't I admire just one thing about you? The fact that you want to quit. Starting there. That's admirable.

SH: What would have been more admirable would have been not starting in the first place.

CR: ...

SH: ...

CR: Now that we're talking about perfection...

SH: What's that supposed to mean?

CR: There's a phrase that comes to mind: 'The perfect is the enemy of the good.' Which do you want to be, Sherlock? Perfect? Or good?

SH: Perfection is impossible. An ideal. Unattainable. And neither of us can honestly believe that I'm  _good._

CR: But that's what you have been looking for. Perfection. Am I wrong?

SH: ...

SH: You're not wrong. But I was-if not  _perfect_ -I don't have those illusions of grandeur, really I don't-then something close. Not perfect. Certainly not good. But-a prodigy. A genius.

CR: Must a genius be perfect?

SH: I DON'T KNOW!  _Why_  must you ask me these questions? I already told you about my childhood, about the trauma. Now why can't we get on with it! Or go back to that, if you prefer. Let's talk about Mycroft, or my father. I'll tell you more about my mother's death. Ask me anything. Open book.

CR: It's easier for you, to talk about the past, than-

SH: Than  _what_? Say what you mean for once!

CR: I'm trying to understand. To understand you.

SH: There's nothing to understand that I don't know already.

CR: ...

SH: I  _am_  a genius. Certifiably so. I've done intelligence tests before. But we both know about the biases in that kind of thing, don't we? So. Genius by the book, genius by popular opinion.

CR: Is that another thing that makes you undesirable? Your brain?

SH: Ha! I've never thought about it that way. Does my brain make me  _undesirable_? I don't usually think about the brain and desire in the same context. Depends on whom you ask. To date, I'd say, 'yes.' My brain makes me undesirable to others. No one wants to be entirely seen, not really.

CR: Entirely seen?

SH: I can see through people. You know that. I can see through you. I've shown you that.

CR: And - did you think it would put me off?

SH: You're a professional. You hide it well. But yes, it generally puts people off.

CR: And so you do it first. Before they can get to know you, you get to know them. You reveal their flaws. Hold up the mirror to them.

SH: Are you surprised that I don't have many friends?

CR: I'm surprised that you keep doing it. And that's something I want to understand better.

SH: I take it time's up.

CR: We've run over, so-yes. Time is up.

SH: Thank you, Carola.

CR: You are welcome, Sherlock.


	12. Letters

**Notes for the Chapter:**

> So I was feeling a bit under-the-weather about my writing today, and the difference in reception between writing PORN (as in Pax americana) versus a psychological fic, but I rallied my spirits with the helpt of some tumblr peeps.
> 
> thanks! to sophiahelix, afrogeekgoddess, roane72, youcantsaymylastname, eldritch-horrors, frankieperry, fizzygins, consultingdepressive, charliebravowhiskey, ladylegolas, esterbrook, verity-burns, stuckinabucket, pennypaperbrain, nympheline. 
> 
> man. that's quite a list of amazing people. thank you!
> 
> and of course -- those of you who have been reading along with me here -- i can't thank you enough for the encouragement.
> 
> emma

Letter No. 1

4 June 2002

My dear brother:

I hope that this letter finds you better than when we last saw each other. After our last meeting -- quite unexpected on my end, let me assure you -- I hoped that you would want my support going forward. After thinking the matter over thoroughly, and discussing it with some trusted friends, I have come to the conclusion that your recent behaviour is a call for help. I am willing to do what I can to aid you as you fight your dirty habit, and I am confident that you will be able to right yourself, given the proper guidance.

The director of Blakely House, Dr Franklin, has informed me that she cannot allow me to visit you without your invitation. Therefore it was quite distressing to learn that you did not wish to see me last week when I brought your instrument. Do you think that you can continue to use others and never give them anything in return? You were always such a self-absorbed child. Until you start to think about others before yourself, I expect I’ll have to keep pulling you out of scrapes, won’t I? Well, I pledge to do what I can. You must know the lengths that I am prepared to go for you. And -- just think of the position you could have, if you would only stop this childishness!

I spoke with one Detective Lestrade of the Metropolitan Police this week. He was quite pleased with your contributions to his cases. But do you really think that solving crimes of passion is a worthwhile use of your -- dare I say it? -- not inconsiderable talents? If you are set on being a dilettante, by all means, go ahead and fritter away the rest of your days. If you insist on being a detective -- and I shudder to think of what trade you’ll ply yourself to next -- perhaps you might consider working for the same office that employed your father and grandfather, and which is currently my employer? 

Think on it.

Yours, fondly,  
  
\--M

___________________________________

  
Letter No. 2

7 June 2002

O caro Mycroft mio:

I can hardly think of a situation in which your letter would find me  worse  off than when we last met. If you recall, I was intoxicated and nearly psychotic when we last parted ways. You will be pleased -- or, as is your wont, smugly self-satisfied -- to learn that I did not ferret away any cocaine with me, nor have I been able to procure either of my drugs of choice during my residence at this facility. You may not believe me, but I really am keen on kicking this ‘dirty habit,’ as you so reverently put it.

Ah, yes. The question of your visiting me. It never fails to astonish me how you can treat me with such scorn and self-righteousness, and then profess ignorance as to why I would not want your company. 

It may come to a surprise to you, although I think it should not, that I am not interested in working for your employer.

Shall I elaborate on the reasons?

1\.     I am, as you so eloquently point out, a childish, self-absorbed dilettante. What use would Her Majesty’s Secret Intelligence Service have for a person of my character?

2\.     Invasion of Britain’s former colonies in order to prevent terrorism is not a morally tenable, nor politically wise, approach to foreign policy.

3\.     Unless you included some clause in our father's will of which I am not aware -- highly doubtful, as I have directed considerable attention to that sham of a document in the last three years -- my financial situation is, for the present and foreseeable future, stable. 

4\.     The working hours at the SIS are not compatible with a concert violinist's rehearsal schedule. 

5\.      My supervisor at Six would be the same megalomaniac who happens to control my legal right to draw upon my own inheritance. 

6\.   Nepotism does not make for sound hiring practices, last time I consulted with someone in human resources. 

Most sincerely,

Sherlock Holmes

___________________________________

  
Letter No. 3

9 June 2002

Sherlock:

A simple 'no' would have sufficed. 

I offered you a job because a man of your intelligence and abilities should  not be allowed to waste his twenties in a drug-induced haze. And, more importantly, because you are the most qualified person for the position I have in mind. It might placate you to know that I was not thinking of hiring you for my division but rather wanted to ask you to submit an application for an open position at the Home Office. 

I know that I am not an emotive person, but I do care for you, Sherlock. I wish that you would let me do something for you instead of insisting, as you always do, on making your own way in the world. With great privilege comes great responsibility.  Why don't you use your privilege to some other end than your own amusement?

-M

___________________________________

  
Letter No. 4

11 June 2002

My My My--

I should have anticipated that you would repeat that old adage about privilege and responsibility. I have no responsibility except to myself. To live. 

~SH

___________________________________

  
Letter No. 5

~~ 11 June 2002 ~~

~~ Mycroft:  
~~

~~ You are an arse. Didn’t you know that? A smug, self-satisfied, FAT arse. Oh yes, you are.  
~~

~~ ~SH ~~

___________________________________

  
Letter No. 6 

~~ 11 June 2002 ~~

~~ My--  
~~

~~When I get out of here, I am going to get a lawyer. A proper lawyer. And I am going to prove that I am of sound mind and sound body  
  
My -- ~~ ~~  
I don’t think what you did with our father’s will was legal. I am of majority age now and I should be able to control my portion of the estate.~~ ~~  
FUCK.~~ ~~  
What I would do for a cigarette right now. Can you bring me a cigarette? Sneak them in another violin case? Or better yet, bring me my viola.~~

___________________________________

  
Letter No. 7

12 June 2002

Mycroft:  
  
Could you arrange to have my viola sent to Blakely? I require the following scores, which you may find in the top drawer of my dresser at the Montague St flat:

  1. Hindemith’s Trauermusik (can’t remember the opus no. -- it’s the only Hindemith in the drawer)
  2. Schubert’s Arpeggione
  3. Bach’s Suites for cello 
  4. Bartok’s sonata for viola



I am also in need of the larger shoulder rest. Not the inflatable one; the wooden one made of light birch, with the adjustable screws. It may be found in the second drawer in the same dresser.

Thank you.

Sherlock

___________________________________

  
Letter No. 8

14 June 2002

Sherlock:

I will ignore that existentialist drivel of yours because I know you don’t really mean it.

Of course I will arrange for the viola to be sent to you. Taking up the old  da braccio  again, little brother?

My assistant, Hyacinth, will bring it over the weekend. You do forgive me for not coming myself; after the cold reception last time, and the pointed absence of an invitation in your last letter, I’m afraid I don’t dare venture to Blakely again.

As always, if there is anything else that I can do for you, you need only say the word. 

Your loving brother,  
Mycroft Holmes

  
  
  



	13. Session No. 7

**Notes for the Chapter:**

> I have missed writing this! The last month I have been tied up with end-of-semester matters and big dissertation deadlines. But I didn't want to leave Sherlock -- or you -- hanging, and so I'm back to writing. Hoping to post twice a week to make up for lost time.
> 
> Best,  
> Emma
> 
> P.S. I apologize if you have written me a comment and I didn't respond to it yet. I am not a terribly important person, and yet my outside life has been extraordinarily hectic. I value and appreciate every comment and I do my best to answer them, even if it takes me a while.

Session Note

 

_Confidential. For training purposes only. Do not circulate._

Date: Wednesday, 12.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 7.

 

\-----

 

SH:      I want to talk about sex.

CR:      …

SH:      Isn’t that what Freud did? Ask his patients to talk about sex?

CR:      Among other things, yes, he was interested in their sexual fantasies.

SH:      And in their sexual traumata.

CR:      Greek too?

SH:      Heidelberg. They’re old-fashioned, there. Not nearly as useful as German, but I had to learn both. Are you trying to distract me, doctor?

CR:      Not at all. You wanted to talk about sex.

SH:      I think I’ll lie down for this one.

CR:      [inaudible]

SH:      Is it easier to talk about one’s sexual history if the therapist is out of sight?

CR:      Is it?

SH:      I won’t know until I start. But it occurs to me – is that another reason why Freud had his patients lie down? So they wouldn’t be embarrassed?

CR:      Are you embarrassed?

SH:      …

CR:      …

SH:      Turning it back to me, I see.

CR:      Of course I am. Are you embarrassed?

SH:      To talk about my sexual history? I should say not! Bodily functions don’t embarrass me.

CR:      Is sex a ‘bodily function’?

SH:      Is it _all_ that it is, you mean? Because it certainly _is_ a bodily function. One of the species-specific behaviours. Bet they overlooked _that_ one in your biopsych class: fight or flight, feed or _fuck._

CR:      Quite alliterative. Can’t see how I would have forgotten that one.

SH:      …

CR:      Why did you turn?

SH:      I couldn’t see your face, couldn’t tell if you were joking.

CR:      Yes, I was joking.

SH:      I see that now.

CR:      Sex is important.

SH:      You are a Freudian.

CR:      Of sorts.

SH:      So – explain my homosexuality.

CR:      …

SH:      Fine. I still have to do everything, I see.

CR:      Is what you want really an explanation of why you are homosexual? Would that be useful, then?

SH:      It might be. It might be.

CR:      Sticking with facts – what did you want to talk to me about today?

SH:      I suppose that I wanted to shock you.

CR:      Shock me?

SH:      I think you’ll be shocked when you hear about – about me. About what I do sexually.

CR:      Are you going to tell me?

SH:      I thought about making you deduce my sexual history, but that wouldn’t be nearly as interesting as if I were to deduce yours. Not because my sexual history is uninteresting – no, I would probably describe it as _titillating,_ in fact – but because it would take you a tediously long time to figure something out about me.

CR:      I’m not sure I want to try.

SH:      Afraid you’ll fail?

CR:      Afraid I’ll get it right.

SH:      And that would be bad, because? Bad to be _correct_? I don’t follow.

CR:      Because no matter how much I am able to guess – _deduce_ – about you, I am sure that I would be missing something essential. So, I could say, for example, that perhaps once you arrived at university you combatted your adolescent shame over your sexuality by throwing yourself whole-heartedly into sexual experimentation.

SH:      You’re not wrong.

CR:      You combatted shame with exhibition, with excess?

SH:      Yes. The number and variety of my sexual partners—

CR:      --was extraordinary, I am sure.

SH:      Of course. Like everything about me.

CR:      And how helpful was my deduction?

SH:      How _helpful_? That scarcely matters. It was _correct_!

CR:      Well, though I may flatter myself on my observational skills, as your therapist I have to ask myself, always, if my being observant is actually helping you. Because there is probably something that I have missed. And other things that, no matter how well _I_ may see them, you may never be able to see yourself if I just point them out to you.

SH:      Yes, that’s just the beginning of the story.

CR:      And the point of all this is not that I pin you down like some butterfly under glass, but that you work your own way towards some greater understanding of yourself.

SH:      I _hate_ that.

CR:      What?

SH:      It’s so impossible, your goals. Why should _I,_ more than others, have to ‘understand’ myself?

CR:      We all have to understand ourselves.

SH:      That’s a lie. The vast majority of humans do _not_ understand themselves and in fact have little interest in understanding _anything_ about themselves, much less about the world.

CR:      Have you ever met anyone who understood, or who wanted to understand?

SH:      …

CR:      …

SH:      I suppose it wouldn’t be very original to say _you._

CR:      I understand?

SH:      You _want_ to understand. But I can’t see why. Understanding is overrated. Understanding brings pain. Clarity hurts.

CR:      Now we are talking.

SH:      But not about sex.

CR:      I thought we _were_ talking about sex.

SH:      How so?

CR:      Sex is – or can be – an attempt to understand oneself through one’s relations with others.

SH:      Sex is about getting off.

CR:      If it were just about getting off, then why would people spend so much time thinking about it, anticipating it, avoiding it?

SH:      I am not avoiding sex.

CR:      …

SH:      Let me clarify. Here, yes, at Blakely, I _am_ avoiding sex. I may be profligate in my sexual attentions outside of the _manicomio_ but I have no intention of becoming sexually involved with any of the sorry patients I have met here.

CR:      How do you find them, then?

SH:      The patients? I thought that I had made my scorn for them abundantly clear.

CR:      Quite clear. _I_ am the one who wasn’t being clear. I meant your sexual partners. How do you find them, meet them?

SH:      You really want to hear about the London scene?

CR:      I want to understand why you wanted to talk to me about sex. Why it’s important to you. Of course, sex is important to most people. But I want to know why _you_ , Sherlock, want to talk about sex today.

SH:      I just want to get this over with. This whole ‘healing’ process. And if I need to talk about sex in order to understand what happened with Manolo –

CR:      …

SH:      …

CR:      Is that really it?

SH:      Fine. I wanted to get a rise out of you.

CR:      A rise?

SH:      Yes. You go home every night and sleep in your own bed, next to your husband or lover – lover, I’m guessing, judging by the absence of the ring, plus I know that you’ve had children –

CR:      …

SH:      --Your abdominal fat distribution gives it away – two or three? I’d expect a married woman with children to wear a ring, signal to the world just what kind of person she is. No ring. Divorced or separated, then. But still well-shagged, eh? You don’t have the prurient curiosity of the sexually frustrated. I would almost think you weren’t interested in sex for yourself, or in men, if it weren’t for the way you cross your legs when I look too closely at you. You’re attracted to me, aren’t you? And you shouldn’t be. Attraction to a patient is a bit like a teacher falling in love with a student. I’ve been that student, by the way. Oh, the people I’ve been! I nearly got a tutor at Cambridge fired. Apparently when they decided to keep their arcane traditions intact they didn’t include pederasty among them. What a pity. I think we’d all have been better off if we had followed the example of the Greeks.

CR:      Sherlock—

SH:      And what would that make _us,_ I wonder? You are a teacher, of sorts, helping me to probe into the secrets of my unconscious, the hidden iceberg of sentiments and drives –

CR:      Sherlock.

SH:      Carola.

CR:      You really _are_ trying to get a rise out of me.

SH:      It might work a little better if you’d stop trying to be ‘understanding’ and compassionate and all that bollocks. You cannot _possibly_ understand the least thing about me.

CR:      My understanding you is beside the point.

SH:      Oh, right, because I’m here to understand _myself?_

CR:      …

SH:      Let me tell you what I understand about myself. Here you have one Sherlock Holmes, age 25, misunderstood genius. Do you feel sorry for me, yet? You shouldn’t, because I’m not a nice person. Should I repeat myself? _I am not a nice person!_ If that is not apparent by now, then I must be doing something wrong. You should save your sympathy for someone who needs it. There are a few alcoholics around here who seem in need of your crocodile tears. Give them some of your time. You must have enough of it, anyway.

CR:      Meaning?

SH:      I didn’t come on Monday. So you must have had more time. To see others, I mean.

CR:      That’s not exactly how it works.

SH:      Don’t you want to know where I was on Monday?

CR:      Why, yes, naturally.

SH:      So why didn’t you ask me?

CR:      I thought that – I thought that, if it were important, you would tell me.

SH:      I think that your trust in me is entirely misplaced, Doctor.

CR:      …

SH:      That, and I think it’s what you say to patients when _you_ forget to ask them something. So – why did you forget to ask me about Monday?

CR:      Is your trust in _me_ also misplaced?

SH:      What do you mean?

CR:      You trusted me to notice. Noticing means caring. And because I didn’t say anything about you skipping our Monday session, it felt like I had forgotten about you. Let you down.

SH:      Feeling sorry about that, are you?

CR:      Yes, I am.

SH:      Because you _care_?

CR:      Because I care about _you._

SH:      Please.

CR:      What?

SH:      Nevermind. I – it’s better if I don’t –

CR:      …

SH:      Our time is up, isn’t it?

CR:      Yes.

SH:      Thank you.

 

 

 


	14. Session No. 8

Session Note

  _Confidential. For training purposes only. Do not circulate._

Date: Friday, 14.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 8.

 

*********

  
SH:    My brother has been writing to me.

CR:    My--Mike--Mycro—

SH:    Mycroft.

CR:    And what does he say?

SH:    He wants to ‘help’ me.

CR:    …

SH:    Not _help,_ really. He just wants to prove that he is right.

CR:    About what?

SH:    That I should be working for the biochemical weapons division of the SIS.

CR:    Ah. The chemistry background.

SH:    Exactly. But I know what they’d have me doing: puttering around some old lab near Whitehall, testing sample after sample for Anthrax, or perhaps the rare inclusion of sarin gas. Can you imagine _me_ doing that? What a waste. They hire technicians for that kind of thing.

CR:    I can’t say that I know very much about chemical weapons. But -- maybe I’m wrong -- I had thought a specialist would do something more, um, _specialized_?

SH:    I don’t want to be a specialist; that’s the biggest mistake of modern science, encouraging increasing specialisation. We created another Tower of Babel, everyone ends up pigeon-holed in their own narrow disciplines, knowing everything about, for instance, the life-cycle of a London Tube rat, knowing nothing about the important things.

CR:    Such as?

SH:    You want examples? Such as: where does the rat live? Example of land rat or water rat? If water rat, which main sewer system does it inhabit? Does it carry any parasites or pathogens? What would it tell you if a dead man were delivered to Scotland Yard in a coffin that only contained him and one dead rat? What could you deduce about where the man died? The rat could point you in the right direction. But no one even _thinks_ to think about rats in that way. Oh no, exterminate the little beasties, that’s what they want to do. Entirely miss the forensic potential of _Rattus norvegicus._ So I cannot be a specialist. Oh, I need to know a little, here and there, about rats, but _not just rats._ Good god, _shoot me_ if that’s the life I have to lead.

CR:    I thought it was anthrax you would be studying.

SH:    ….

CR:    …

SH:    Don’t be purposefully obtuse, please, Carola. It’s beneath you. Of course I wouldn’t be studying rats if I worked for SIS. It’s the principle of the thing: I don’t want to be a specialist. I want to know _everything_. Even organic chemistry became boring after three years. Music, of course, never bores, but you and I both know how useful _music_ is to me now—

CR:    Still the neuropathy?

SH:    I’ve sent for my viola, if Mycroft _deigns_ to bring it to me. I have a feeling he’ll keep it, though I shudder to think of the noises his fat fingers would pull from it.

CR:    So -- perhaps the viola will -- I mean –

SH:    Why the viola?

CR:    Yes.

SH:    It’s larger. Easier to feel the strings, at least that is what I’ve hypothesized. You see, I’ve had no lack of time while here to consider the situation. I don’t know why I didn’t think of it before!

CR:    Yes. Your time.

SH:    …

CR:    What are you doing with it? I mean -- I’m curious -- the patients here find all different ways to spend their time. But I know you’re seeing me, and Dr Franklin, and going to one or two groups now?

SH:    Social skills.

CR:    One group, then. And -- have you brought many books?

SH:    Ha! Mycroft brought me a few when he came the first time. And I’ve read most of what was in the patient common room and in Dr Franklin’s office.

CR:    Dr Franklin’s office?

SH:    Don’t look so startled! You didn’t imagine that I _broke in_ there, did you? No, we worked out a deal. I agreed to answer her questions if she would lend me her books.

CR:    How has that been?

SH:    Oh, a most satisfactory arrangement, I assure you. We both get what we want.

CR:    I can only imagine. So, let’s see: now you know about chemical dependency, methadone maintenance, adolescent psychopathology, and what else?

SH:    Treatment of personality disorders, family systems therapy, Kleinian psychoanalysis, several books by R.D. Laing -- would have pegged _you_ as the hippie, not her -- a few tomes on diagnosis.

CR:    …

SH:    You’re laughing at me.

CR:    I’m smiling. It’s not every patient who uses rehab to educate himself about psychopathology. But you still haven’t told me what you were doing on Monday.

SH:    I went to the visitor waiting area.

CR:    …

SH:    Oh, don’t make that face!

CR:    What face?

SH:    Like you were going to tell me I shouldn’t be in there! I was disguised, of course. They didn’t know I was a patient.

CR:    Who? Wait -- _what?_ Disguised?

SH:    Yes.

CR:    How?

SH:    It’s not difficult to borrow clothing around here. You will have observed that this is a residential facility, hence, people _reside_. And they bring their clothes: trousers, shirts, bowties, shoes, etcetera. Naturally. Not difficult to get a hold of.

CR:    But didn’t Jill -- Daniel -- the desk -- didn’t they notice?

SH:    I told you, I was disguised. I am very good at disguises.

CR:    You must be. And how did you get out?

SH:    You don’t need to worry about me leaving, if that’s why you’re asking. I’m a _voluntary_ patient, remember? But I’m not going to tell you how I got out.

CR:    Why not?

SH:    Because I might want to do it again. I met someone interesting.

CR:    A visitor? Was it the policeman again?

SH:    Lestrade? No, not him. It was a visitor -- not mine. He was here to see his sister -- alcoholic, relapsed -- but she was in a group when he arrived. He said she had told him to be there at ten o’clock and he was quite miffed when she didn’t turn up.

CR:    And you started talking to this man?

SH:    Yes. I told him I was also there, to visit my brother.

CR:    You pretended to be Mycroft? Visiting yourself?

SH:    Ha! No, I didn’t let the charade go that far. I don’t know if I could stomach being Mycroft for a minute, much less an hour. I just pretended to be visiting someone who had my characteristics -- young, male, cocaine user.

CR:    And he believed you?

SH:    How would anyone know I was a patient, unless I said so? It's not as if I wear a sign that says 'mental patient.' Of course he believed me.

CR:    …

SH:    …

CR:    So you got to talking?

SH:    Yes. I told him what I observed about him -- I guessed right away whose sister he was, the unusual color of his eyes, shape of his mouth. Also guessed that _he_ wasn’t an alcoholic. Too straight-laced.

CR:    Did you tell him that? That he was straight-laced?

SH:    Yes.

CR:    And what did he say?

SH:    He laughed.

CR:    He laughed?

SH:    Yes, I think he was amused. He said I was right. And then I told him that I knew I was right; he was military, of course he was a bit straight-laced.

CR:    What did you like about him?

SH:    How do you know that I liked him?

CR:    The way your mouth is twitching. I think you were amused by him, too.

SH:    It was a way to pass the time.

CR:    And time went by so quickly that you forgot about our appointment?

SH:    …

CR:    …

SH:    It’s not what you think. I was bored.

CR:    What did you imagine I was thinking?

SH:    I told you, it was a way to pass the time.

CR:    Was he fit?

SH:    That has nothing to do with it! He was there, I was there, I talked to him. That’s it.

CR:    So he _was_ fit.

SH:    ...

CR:    ...

SH:    The strange thing was, he was a doctor, too.

CR:    Strange because?

SH:    Because army? _And_ a doctor? I mean, statistically speaking, what’s the chance of that? Britain maintains a standing army of, last I checked, approximately 100,000 troops. And now we’re deploying, oh, several thousand to Afghanistan to help the Americans. We won’t spare more than that, and so of that number, how many can be medical personnel?

CR:    Not very many.

SH:    _Exactly._ Not many at all. Army doctor, recently commissioned, _volunteers_ to go to Afghanistan, not because he believes in the war, exactly, but -- solid middle-class family. Alcoholic sister, father the same. Wanting an escape, perhaps? Leave Old England behind for glory and adventure in the former colonies? Afghanistan _was_ occupied by the British, several times, in fact. It came to nothing then and I don’t imagine that they’ll fare any better this time. At least that’s what I’ve said to Mycroft. But Jo-- he said –

CR:    Who? Mycroft?

SH:    No, the man. He said his name was John.

CR:    …

SH:    He said he wanted to _serve._ And I didn’t believe there were people like that anymore -- Mycroft may be in public service but I’d be lying to you if I said that he was there to _help people --_ but I think he -- John -- I think he may have been _serious._ Alcoholic sister aside, if he wanted to escape, he could always go to Australia! But _Afghanistan!_ What an idiot! He’ll get himself killed and then he’ll be no use to anyone.

CR:    ...

SH:    And now you’re smiling again.

CR:    I am. Because _you’re_ smiling.

SH:    I am not.

CR:      Is he coming again? To Blakely, I mean.

SH:      Next Monday.

CR:      And you’ll see him?

SH:      …

CR:      What does that expression mean?

SH:      If you don’t tell them, I will.

CR:      I won’t say a word.

SH:      Well, then.

CR:      Well.

SH:      Good-bye.

CR:      Good-bye.  
  
  



	15. Letters

7 June 2002

Dear Georgina:

You have probably heard from Mycroft that I am at a drug rehab center in Surrey.

And how are you?

I’ve been given the task of writing a letter to someone as part of my ‘social skills’ group here at Blakely House. I thought you’d appreciate the assignment and so you are to be the recipient of the letter.

I believe it has been three years since we last saw each other. If this letter reaches you, it means that you are still living in Edinburgh, because that’s the last address of yours that I remember.

Things started to go a bit fuzzy a year ago. Or perhaps before that, if you believe Mycroft.

There is not much to do here at Blakely other than read, read, read, and observe the other patients. If you are so inclined, and if you receive this letter, please consider responding. It would amuse me to hear from you. And you may be amused that I have started to read poetry.

Yours sincerely,

Your loving cousin,

Sherlock Holmes

P.S. This letter has been reviewed and approved by Dr Gupta. The next one will be private.

 

****

9 June 2002

Dear Sherlock:

It is so lovely to hear from you! I haven’t received a real letter in months, just bills and catalogues. I have been thinking a lot about you, actually.

Yes, Mycroft had told me where you were; he calls me nearly every month to check on my health. After Sigur’s death your brother sort of took things over, did the things _he_ would have done. And I know your father _would_ have called me every month, out of duty if nothing else, and I think Mycroft is trying to be like that. Carry on the Holmes tradition, etc. But you know I’d much rather hear from you, anyway.

I’m also having trouble with drugs, but of the legal kind. They haven’t been able to find the right combination and I’ve been trying one cocktail after another. I had my last attack in February and things have got better since then but there are days when I still don’t feel like normal. I have almost given up painting, if you can imagine that? Sometimes I try to convince myself that I’ll be like one of those paraplegic artists who paints with the brush in their mouths, but the MS version. Would that make me famous, I wonder? Seems like a cheap trick: “Artist struggles to complete painting in face of chronic illness.” Might sell a few more but that’s not what I want to be known for. And now I’m starting to feel depressed because I don’t know if I’ll be known for anything, ever.

I was thinking about you because my friend Jill traveled to Andalusia this year and took the most gorgeous photos (she’s a photographer). I’ll always remember that summer that I spent there with you and your grandmother, before your mother died. You were nine, I think, and I was thirteen or fourteen – about to turn fourteen. I was so impressed that you could speak Spanish and that you knew your way all around the city. I was your shy English cousin, prim and proper and all so very Holmesian ( _you_ know what I mean) and you were this wild street urchin, all ragamuffin and Oliver Twisty. I think that it was then that I realised that you and I were two of a kind. And even if you couldn’t forgive me for wearing a white dress to church, you knew it, too, knew that we were alike. That’s what I’ve always liked about you, Sherlock. Even when you were a child, you were _so smart._ You knew I wasn’t like the others, even though I was a girl.

But I bet that there are things that you didn’t know about yourself then, or don’t know about yourself now. You were not only a smart child, you were also beautiful. Do you know that? You were _such_ a beautiful child, almost too beautiful for words. I should have envied you but I liked you too much to be jealous. Does that surprise you? That I liked you so much, when you were younger? You may have been younger but you were much worldlier than I was, Sherlock, much more in touch with something darker, like Lorca’s _duende_.

I think sometimes that I would like to do a portrait of you, as you were when you were younger. Would you like that? When I can paint again, I mean. I’d call it ‘ _Duende_ ’ and sell it in some high-end London gallery and everyone would wonder who that pale boy with the large slanted eyes was, and I wouldn’t tell any of them, because it would be our secret, just like when we were younger.

Here’s _my_ secret: I’m very sick, Sherlock. Very, very sick. And I can only tell you because you are also ill, though in a different way, and you won’t pity me. So do write back to me. Write to me when you’re done there (YOU _WILL_ BE DONE, won’t you? Done with the drugs…), and come to visit me whenever you like. There’s a sofa with your name on it.

What poetry are you reading?

XOXO,

Georgie

 

****

11 June 2002

Georgie:

I may have been smarter than the average nine-year-old but I was not a beautiful child. You exaggerate. Nine-year-old boys are not beautiful. Most of them are smelly because they do not bathe frequently enough. And they find it amusing to joke about flatulence and tits (not together). I was no exception, as I am sure you remember.

You may be surprised to hear that I’m in here because I want to get clean. That’s the point of rehab, of course, but what I mean is that no one (Mycroft in particular) is forcing me to be here. I also want to get well.

When I was a child I looked forward so much to being an adult (mostly because I thought I’d be smarter than Mycroft once I was older) and now that I am ‘grown up,’ I have nothing to show for it. In case you are going to remind me of my doctorate, that was a joke, too, just playing around the lab. Chemistry wasn’t difficult, you see, and nothing that is easy is worth the effort. So I have a piece of paper with a posh degree, and I have an expensive violin that I can’t play anymore (we have the neuropathy in common, oh dear cuz, though the etiologies be different…), and I have a slovenly little flat on Montague Street, and I have – oh, two thousand? Four thousand? Not enough books to make a library but enough to impress the undereducated. And I’m here, detoxing. Alone, as usual. Who would want _me?_ You’re my cousin and you’re the wrong sex, and older besides, so don’t say that you’d want me.

I met a soldier here yesterday. Not a patient, a visitor. I would imagine that the military takes care of their own when one of them loses his mind, so the chance of meeting a soldier as a patient is pretty slim. Are there any military bases up your way?

I am reading the metaphysicals, mostly.

~SH

 

****

14 June 2002

Sherlock:

I am not _that_ much older than you are. But I suppose I’m glad that you’re not encouraging me towards incest, right? I thought that ended with great-grandfather and granny Hilda.

So you’re reading poetry, and the metaphysicals, no less! This from one who swore himself a scientist and man of reason…How I love your contradictions, Sherlock! And so _very_ metaphysical, too. Do you prefer Marvell or Donne? Donne, of course. (‘Death, be not proud…’) But let me recommend that you also read Marvell’s ‘Dialogue between the soul and the body.’ Are we souls enslaved in our bodies, or bodies bound to tyrannical souls? You tell me. I think the question is especially pertinent for those of us who are ill, whose bodies have betrayed us. Maybe I’m overstepping myself here, and you don’t consider yourself ill, but I think we have that in common, at least: renegade bodies.

Today was a good day for me (for my body?). I was able to paint a little in the morning and I took my neighbour’s dog for a walk in the afternoon. I also received your letter, which made it even better. Please don’t stop writing; I like hearing from you even if you don’t think you have anything new to say. It will all sound new to me because my life is so boring these days, even a rehab centre is more exciting than what I’m going through! If I know you, you’re probably torturing your therapists and making life a living hell for the rest of the patients. But I’d still rather see you than any other member of our family. So do me a favour and come visit when you get out, will you?

~Georgie

17 June 2002

Georgie:

Thank you for your invitation. I do not yet know what I will do once I leave Blakely. I was thinking of perhaps visiting my grandmother in Seville but an invitation to Edinburgh is most welcome. Thank you.

Sincerely,

Sherlock

P.S. This letter was approved by Dr Gupta.

17 June 2002

Georgie:

What I said in the other letter was all true – I would like to visit you when I get out – but the therapist for the social skills group insists on reading our letters before we post them so I had to devise something brief that would suffice for that purpose.

And now – not much to report from Blakely. It would have been more interesting if I had gone to one of the central London hospitals where they send the homeless and the junkies from the council estates. Instead I’m here with: 1) an Australian film star; 2) the son of a MP; 3) one horrid Cambridge maths tutor who insists on lecturing about Ramanujan and the concept of zero to whomever will listen (and has very hairy ears); and various other personages of lesser importance. I am bored.

When I am bored, I start devising ways to make Mycroft’s arse even tighter than it already is. Do you have any suggestions? So far, I’ve thought of the following: 1) filing an anonymous report to the Met Police accusing MH of rigging the East End elections; 2) calling a meeting between his attorney and mine to discuss the status of our father’s will; and 3) planting Sigur’s grave with purple pansies, entirely for the metaphorical effect (Although ‘pansy’ was the least of the insults he threw my way, it is the one most suited to floral arrangements.).

Today seems to be a day of lists. Would my therapist say that this is ‘obsessive-compulsive behaviour’? I wonder. She doesn’t often label my behaviours as symptoms. Perhaps I need a new therapist; she doesn’t seem to think there’s anything wrong with me. I agree (Other than the cocaine and opioids, that is. You can't say that I'm in denial.). But why must one’s efforts to organize the world be taken as symptoms of psychopathology?

~Sherlock

****

20 June 2002

Sherlock –

I don’t know anything about psychopathology, I admit. The people I admire are more of the ‘mad poet’ types in any case, so they are more likely to seek out madness than avoid it.

Another poem for you:

Much madness is divinest sense

To a discerning eye;

Much sense the starkest madness.

’T is the majority In this, as all, prevails. __

Assent, and you are sane;

Demur,—you ’re straightway dangerous,

And handled with a chain.

 

Do you know this one? I am assuming that you don’t usually read poetry so this one may be new for you. But I thought it was apropos.

My neighbour is baking scones and he has invited me down to his flat for tea. I will write more later when I am not so exhausted.

Love,

Georgina

P.S. I hope you’re not just saying that you’re going to visit but that you’re actually going to come to Edinburgh. I don’t know any soldiers but I know plenty of men who you might like.

 

 


	16. Session No. 9

**Notes for the Chapter:**

> There is now coverart for this fic!
> 
> Sherlockscarf has made an amazing photomanip cover for In Confidence. Check out the 'related works.'
> 
> http://archiveofourown.org/works/444042

Session Note

  _Confidential. For training purposes only. Do not circulate._

Date: Monday, 17.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 9.

_______________________________________

CR:      Good morning.

SH:      Morning.

CR:      You’ve been here over three weeks.

SH:      Yes. Twenty-two days.

CR:      I need to write a progress report today. And we need to talk about how long you’re staying here.

SH:      We? Is this a joint decision, then?

CR:      No, it’s your decision. But we need to talk about it. Talk about what you’ll do next, and how long you want to stay.

SH:      I don’t _want_ to stay here any longer than I have to.

CR:      I hear a ‘but’ here somewhere.

SH:      Has it really been that long?

CR:      The first week often goes by quickly. The body is detoxing. People don’t always remember the first few days.

SH:      I haven’t forgotten. Much.

CR:      That’s good.

SH:      …

CR:      …

SH:      Do I have to make a decision now?

CR:      No. But we need to start talking about it. Because – 28 days – that’s not so far away, actually. About a week from today.

SH:      What do _you_ advise I do?

CR:      I’m here to help you think about it.

SH:      Indeed. I wouldn’t expect anything less.

CR:      Yes.

SH:      Just when things were getting interesting.

CR:      What has been getting interesting?

SH:      I have a penpal.

CR:      The soldier? Did he come back?

SH:      Yes, he came back. _Not_ my penpal. But I was referring to my cousin. Georgina.

CR:      Georgina? You haven’t mentioned her before.

SH:      She lives in Edinburgh. I wrote her some letters, in my ‘Conversation Group’. Or ‘Big Brother’s Epistolary Society,’ as I like to call it. The others wrote to their parents or their lovers. I don’t have either. Don’t pity me, Carola! I can’t help being an orphan and I don’t want a lover.

CR:      You don’t want a lover?

SH:      Though as long as they let me alone to write my letters, I can’t say I mind the group, much. Except for the fact that Dr Gupta insists on reading them – ridiculous! How can they expect me to write anything honest if you doctors are peering over my shoulder? Is this a prison or a hospital?

CR:      You don’t want a lover?

SH:      It’s always sex with you, isn’t it?

CR:      …

SH:      I think sex is only important to people when they’re not well laid.

CR:      You don’t want a lover?

SH:      No. No. No. _Not love._ Sex. Sexers, perhaps? Can I invent a word? Sexers? Shaggers, perhaps?

CR:      Shaggers?

SH:      People I shag. _Men_ I shag, I should say.

CR:      …

SH:      Carola, my dear, you look a bit faint.

CR:      …

SH:      …

CR:      And you like to think that you’re shocking me.

SH:      I’m used to shocking people.

CR:      Tell me more about Georgina.

SH:      She’s an artist. She’s a few years older than I am. Holmes side of the family, but she’s more like a Portnoy or a Mejía Santos. Isn’t a complete arse, I mean.

CR:      She’s an artist. Is that something you have in common? Art?

SH:      Yes. Art and music. She doesn’t play, but she enjoys it.

CR:      How did you decide to write to her?

SH:      Who else would want to hear from me?

CR:      Mycroft?

SH:      I’m not giving him that satisfaction.

CR:      So Georgina is tolerable.

SH:      Exactly.

CR:      Is she someone you could live with?

SH:      Live with?

CR:      I’m thinking about what you’re going to do once you leave here.

SH:      I’m going back to my flat. Nothing wrong with it, is there?

CR:      Sometimes, when people use drugs, they form associations between the places they use and the high from the drugs. So it can be hard to go back to the same place you were at before, and to try to avoid the drugs when you get back.

SH:      I’m not surprised to hear that. It’s really quite elementary psychology, pairing of a stimulus and a response. Classical or operant conditioning?

CR:      What’s important is finding you a place you can live when you get out that doesn’t trigger another drug binge.

SH:      I would hardly classify my drug use as ‘binges’.

CR:      …

SH:      …

CR:      You were intoxicated when you came here.

SH:      Intoxicated, yes. But it was always controlled. Nothing impulsive or compulsive about my drug use. Not a binge, which by definition _is_ uncontrolled.

CR:      We can argue about semantics or we can talk about what you’re doing when you leave here.

SH:      I don’t want to leave yet.

CR:      That’s fine, too.

SH:      Is it? Don’t you want to know why?

CR:      …

SH:      I’m not really sure, myself. What do you think?

CR:      There are lots of reasons why people extend their stays here.

SH:      I don’t care about what _other_ people do. I want you to tell me why _I_ want to stay.

CR:      You want to stay because you’re interested in this, in therapy, and in what you’re learning about yourself. At least, that’s how it seems to me.

SH:      Very good. I thought you might settle on something more obvious.

CR:      Such as?

SH:      The visitor in the waiting room.

CR:      You haven’t told me much about him. Is he coming back? Is he important?

SH:      He might be. Yes. No. I don’t know. I only saw him for a few minutes this morning. His sister was on time today. I would have thought she’d done it on purpose, if she had any idea of things.

CR:      Done what on purpose?

SH:      Arrive on time so I couldn’t keep talking with her brother.

CR:      I see.

SH:      …

CR:      No, I don’t, actually. This person, this soldier – is he important? To you, I mean?

SH:      I hardly know the bloke.

CR:      Do you want to know him?

SH:      …

CR:      Sherlock?

SH:      Obviously. Must I spell everything out for you?

CR:      I am afraid you must.

SH:      Yes, I’d like to know him. Or, I should say, know him better. Technically, I _do_ know him. I’ve met him twice, and I know his name, and what he wants to do with his life, and how he feels about his sister, and what he thinks about the war in Afghanistan – unfortunately, he has the wrong opinions, but he’ll change his mind once he’s there, I know the type, idealistic but easily disillusioned. You could say that I know him.

CR:      Does he know _you_?

SH:      Of course not! He thinks I’m another visitor. He doesn’t know _me._

CR:      Do you want him to? To know you, I mean.

SH:      What does it mean to _know_ someone? I know you, I suppose, and you know me as well as anyone does. Do I want him to know me? No. Not now.

CR:      Not now. Because?

SH:      Because I’m a fucking patient in a drug rehab centre. No, I do _not_ want him to know me right now. This is hardly an ideal time.

CR:      And if it were? What might that look like?

SH:      What use are hypotheticals? I’m never going to see the man again. There’s no reason to speculate about what could be.

CR:      I like hearing about your fantasies. I think this is the first time that you’ve mentioned something that you actually want.

SH:      Did I say that I want him? I don’t recall having said that I wanted anybody. In fact, I think I was quite deliberate when I said that I don’t want a lover. I don’t. I’d be rubbish as a lover. I’m rubbish as a friend, as a brother, as a son. What makes you think I’d be any better as someone’s lover?

CR:      You are very hard on yourself. Do you think that everyone is a good lover the first time around? That others don’t make mistakes, too?

SH:      I don’t think I’m too hard on myself.

CR:      …

SH:      Is it true, what they say about depressed people?

CR:      What do they say about depressed people?

SH:      That they see the world more clearly, more realistically.

CR:      Oh, yes. That’s what the studies say.

SH:      The studies, your studies…If that’s the case, then I might as well stay depressed, keep up my acquaintance with the black dog. To see the truth, I mean. It’s worth it, I think.

CR:      …

SH:      It’s disgusting how many people fool themselves into thinking that things are better than they are, deluding themselves that they are happy, that they are important. Oh, those meagre little minds!

CR:      You don’t want to be deluded.

SH:      Correction: I have _never_ been deluded.

CR:      And so you deny yourself fantasy, and desire.

SH:      Who said anything about denying myself desire? I told you, I _do_ pull from time to time.

CR:      Having sex isn’t the same as desiring someone else. That’s why I want to know about this man, about what you think about him. Even if you never see him again, I think it’s important for you, to understand why you’re attracted to him. It might tell you more about yourself.

SH:      Honestly – and I _can_ be honest here, can’t I? – I’m a bit tired of learning about myself. It would be nice to focus on someone else for a change.

CR:      Is that why he’s interesting to you? Because you can focus on someone who isn’t yourself? Something that isn’t your addiction?

SH:      …

CR:      Sherlock?

SH:      This is boring.

CR:      I don’t think so. I think this is _fascinating._ I think you say that things are boring when you don’t want to think about them.

SH:      Not true. I think about _everything,_ and I discard what isn’t interesting.

CR:      Then why is it so hard for you to talk to me about the soldier? Whatshisname, Joe?

SH:      John. His name is John. And I don’t have a _problem_ talking about him. What do you want to know? That he’s shorter than I am? Most people are. That he has that light shade of hair that suggests that he was a towhead as a child? True for about twenty-percent of Englishmen. That he’s a thrill-seeker, an adrenaline junkie – why else would he sign up for the army? Foolish man. Thrills can be had anywhere, there’s no point in risking your life in a rich man’s war. Yes, I called him foolish. Told him so, too. That’s why I won’t make a good lover. Because everyone’s an idiot, there’s no point in hiding the truth, but people don’t like that. Not from friends, certainly not from lovers.

CR:      What did you tell him, exactly?

SH:      I told him he was foolish to join the army when there was so much more that he could do in London.

CR:      Such as?

SH:      Work in an A&E, for one. That’s where the thrill-seekers usually spend their time. I would know, I’ve been there enough myself.

CR:      How many overdoses have you had?

SH:      Not overdoses. Accidents. At least that’s what I tell them. Fist-fights, actually.

CR:      Fist fights? And you’ve managed to avoid an ASBO?

SH:      Perfectly legal, I assure you.

CR:      …

SH:      Boxing.

CR:      Ah.

SH:      Among other things. I was a boxer, originally, but I wanted more of a leg workout, so I started to go to a dojo. Sensei there is from Kyoto, or says he is. I have my doubts.

CR:      Sherlock.

SH:      That’s my signal, isn’t it?

CR:      Yes.

SH:      So, I can stay another week?

CR:      Yes. It’s up to you, remember.

SH:      And you’ll let Dr Northrup know?

CR:      I’ll let her know.

SH:      Good.

CR:      See you on Wednesday.

SH:      Yes.


	17. Official correspondence

**Notes for the Chapter:**

> A few readers were curious about whether or not it was true that depressed patients see the world more realistically than non-depressed patients. There has been a lot of research on this topic, and wikipedia conveniently provides a good summary:
> 
> http://en.wikipedia.org/wiki/Depressive_realism
> 
> However, as one comment on FF.net pointed out, even if depressed people DO see the world in a more realistic fashion, that isn't necessarily a good thing. Some level of self-delusion is apparently desirable, which is very interesting! But of course Sherlock, with his constant search for truth, would prefer to be depressed and realistic than to be happy and deluded. :)
> 
> I also recently published a post on tumblr about Sherlock and bipolar disorder, which you can find here:
> 
> http://emmadelosnardos.tumblr.com/post/26501220783/bipolar-disorder-and-sherlock-holmes

From: **Carola Rivas** <rivas@blakely.org.uk>  
Date: Mon, 17 May 2002 at 12:02  
Subject: SH in group  
To: **Dr Shavani Gupta Chakravorty** <gupta@blakely.org.uk>

Shavani:

I’m writing a progress report for SH and I wanted to ask you for some information about how he has been behaving lately in the group therapy.

As a reminder, these were the treatment goals that he and I originally agreed upon that are relevant to the group:

**Goal 3: Staff will report improved social functioning of SH at Blakely House.**

**Objectives: Pt will attend Social Skills Group and adhere to group rules.**

Could you send me a few lines about his involvement in the group?

Thank you in advance,

Carola

_______________________________________

 

From: **Dr Shavani Gupta Chakravorty** <[gupta@blakely.org.uk](mailto:gupta@blakely.org.uk)>  
Date: Mon, 17 May 2002 at 13:21  
Re: SH in group  
To: **Carola Rivas** <rivas@blakely.org.uk>

Carola:

You can add this to the progress report:

_Patient is making some progress towards this goal. Pt has shown moderate improvement in behaviour in the Social Skills group. He has participated in group activities such as: letter-writing, sharing of personal histories, and giving compliments to others. After an early altercation with another group member, SH has demonstrated some improvement in his relationships with others. For example, he is able to engage in reciprocal, appropriate conversations with others. However, the pt continues to make inappropriate facial gestures when listening to certain members of the group. He has also been vocal about his dislike of the group and his resentment at having to participate._

Between you and me, it’s easy to write that he showed improvement, given his baseline. I doubt that SH could have demonstrated any worse behaviour in the group without being asked to leave Blakely. This won’t be news to you, but SH was an extremely difficult patient to have. He was resistant to participating in many group activities and only joined in after the group reflected on the process together and told him that he needed to get his shit together (yes, HM used those words!). I don’t like shaming as a group therapy tactic but in this case it seemed to work. He was much more compliant after the incident.

I know you had his best interests at heart when you referred him to the group, but in the future I would ask that you allow me to interview potential group members before you made a referral.

Let me know if there’s anything else that I can do.

Cheers,

Shavani Gupta

_____________________________________

 

From: **Carola Rivas** <rivas@blakely.org.uk>  
Date: Mon, 17 May 2002 at 13:44  
Fwd: Subject: SH in group  
To: **Dr Mariah Franklin** <director@blakely.org.uk>

Mariah:

See attached note from Dr Gupta.

What do you think about her request to interview potential group members before they are referred to the group? Seems to me like it will take too much time to coordinate, and patients will start group therapy late.

~Carola

______________________________________

 

From: **Dr Mariah Franklin** <director@blakely.org.uk>  
Date: Mon, 17 May 2002 at 14:09  
Re: Fwd: Subject: SH in group  
To: **Carola Rivas** <rivas@blakely.org.uk>:  
Cc: **Dr Shavani Gupta Chakravorty** <gupta@blakely.org.uk>

Carola and Shavani:

I can understand Dr Gupta’s concerns, but we’ll keep things as they stand for now. No interview needed for referrals to groups.

Cheers,

Mariah

**Dr Mariah Franklin, MB BChir, MRCP  
Director and Attending Psychiatrist  
Blakely House  
Surrey RH1**

_____________________________________

 

From: **Carola Rivas** <rivas@blakely.org.uk>

Date: Mon, 17 May 2002 at 14:14  
Subject: SH in group  
To: **Dr Shavani Gupta Chakravorty** <gupta@blakely.org.uk>

Shavani:

Thanks for the thorough progress note. I am not surprised that S was a difficult person to have in the group; that is what the group is for, after all – to improve our patients’ social skills.

Interviewing the patients before they are referred to group sounded like a good way to determine the appropriate fit. Maybe in the future, when we aren’t so stretched for resources, we can figure out a way to put your idea into action.

Talk soon,

Carola

 

_____________________________________

 

Date: Monday, 17.6.2002

Treatment Progress Note

Therapist: Carola Rivas, Ph.D.

Mr H is a 25-year-old White male who was admitted on 26.5.2002 while intoxicated with cocaine. Mr H is a cocaine and heroin user with symptoms of a mood disorder.

Mr H has participated in individual psychotherapy, 3X weekly, with this writer, for a total of 9 sessions. Patient also has participated in the Social Skills Group with Dr Gupta. Dr Franklin is his consulting psychiatrist. Mr H is currently taking 100mg/d of methadone.

The patient has expressed an interest in remaining at Blakely House for a total of five weeks. Expected discharge would occur on Monday, 1.7.2002.

**Progress towards goals:**

**1.** ** Goal 1: Pt will reduce dependence on heroin and cocaine. **

  * **Pt will adhere to methadone maintenance therapy as directed by his psychiatrist.** _Patient has achieved this goal. Blood tests and urinanalysis confirm that patient is not using illicit substances and patient is adherent to methadone maintenance therapy._
  * **Pt will identify triggers for substance use.** _Patient has not achieved this goal. Patient denies relationship between family problems and onset of substance issues._
  * **Pt will create sobriety plan for after discharge.** _Patient has not achieved this goal. Patient will discuss sobriety plan with his psychiatrist and psychologist in the coming week and write a plan before discharge on 1.7.02._
  * **Pt will attend scheduled appointments following discharge**. _Not applicable. This goal is for after discharge._



**2.** ** Goal 2: Pt will report fewer mood symptoms. **

  * **Pt will use words to describe his mood state**. _Patient is making progress towards goal. Patient has shown improvement in being able to name and discuss his emotions._
  * **Pt will identify activities that bring him pleasure.** _Patient has not achieved this goal. This goal has not been a specific focus of psychotherapy to date._
  * **Pt will engage in pleasurable activities on a daily basis.** _Patient is making progress towards goal. SH reports playing his violin and reading books on a daily basis, activities which he appears to enjoy._



**3.** ** Goal 3: Staff will report improved social functioning of SH at Blakely House. **

  * **Pt will attend Social Skills Group and adhere to group rules.** _Patient is making some progress towards this goal. Pt has shown moderate improvement in behaviour in the Social Skills group. He has participated willingly in group activities such as: letter-writing, sharing of personal histories, and giving compliments to others. After an early altercation with another group member, SH has demonstrated some improvement in his relationships with others. For example, he is able to engage in reciprocal, appropriate conversations with others. However, the pt continues to make inappropriate facial gestures when listening to certain members of the group. He has also been vocal about his dislike of the group and his resentment at having to participate. [Signed Shavani Gupta]_
  * **Pt will obey Blakely House rules regarding behaviour towards others.** _Patient has made progress towards this goal but still must work to improve his relationships with other Blakely Patients._
  * **Pt will use psychotherapy to talk about social and family relationships.** _Patient is making progress towards goal. Patient is well-related to the therapist and has shown an increasing willingness to discuss personal issues in therapy._



 


	18. Session No. 10

Session Note

_Confidential. For training purposes only. Do not circulate._

Date: Wednesday, 19.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 10.

_______________________

CR:      We have five sessions left, counting today.

SH:      I’m so pleased that you can count, doctor.

CR:      So we don’t have much time. And there are still some things that we haven’t talked much about. Like your drug use. Do you want to talk about it, today?

SH:      I wondered when you were going to get around to asking me about that.

CR:      Drug use is a distraction. It distracts you from what’s really going on in your life, from the things that hurt. And it can distract you in therapy, too, if you’re too focused on the drugs to talk about yourself.

SH:      So you’re saying that there’s a reason why we haven’t talked about my drug use?

CR:      If you had wanted to talk about it, yes, we could have talked about it. I like to wait a bit, to see what my patients want to talk about. That’s more interesting than if I set the agenda.

SH:      That’s a convenient explanation if you’ve overlooked something important.

CR:      Could be, yes.

SH:      My drug use. What did you have in mind?

CR:      How did you start? Let’s begin at the beginning.

SH:      …

CR:      Sherlock?

SH:      Which drug? Nicotine? Cocaine? Opioids?

CR:      You started with cigarettes when you were, what, twelve years old?

SH:      Yes. The year my mother died, as you have observed.

CR:      Well, it’s interesting to know when you started to use _any_ kind of drug, but as you know, it’s really more the cocaine and heroin that concerns me.

SH:      So you don’t care if my lungs rot when I’m sixty?

CR:      Do you want your brain to rot when you’re thirty?

SH:      …

CR:      I thought not. Either cocaine or heroin alone will rot your brain. Together they’re the worst thing you can do to yourself. We’re talking serious cognitive deficits if you keep using.

SH:      I use in a very controlled fashion.

CR:      Right, and the overdose was controlled, too?

SH:      Yes. I already told you that. Why do we have to go over this again?

CR:      Sherlock, Dr Gupta tested your intellectual abilities, didn’t she?

SH:      Yes. If you can call those elementary _puzzles_ a _test._

CR:      Good. So we’ll have a baseline.

SH:      What’s that supposed to mean?

CR:      Your cognitive faculties are intact right now. I’d prefer for them to stay that way – you really do have an exceptional mind, you do know that?

SH:      …

CR:      But if you don’t stop using, then you’ll be back again. Oh, maybe not back here in Blakely House – depends on where you’re living, and what kind of treatment you need. But if you keep using, you’ll be back in treatment eventually. And so we’re taking the tests now, so that they’ll have something to compare you to, in the future. Some way of knowing what the drugs are doing to you.

SH:      Fuck you. I know perfectly well what the drugs are doing to me.

CR:      …

SH:      Cocaine helps me to think. Heroin shuts off the thoughts.

CR:      As long as you’re on them, yes, that may be what they do. But long term? Forget heroin for the moment. Sustained cocaine use will lead to memory deficits, problem in motor coordination, decreased verbal skills. I’m surprised that I have to tell you this, Sherlock.

SH:      The studies are flawed. I’ve read them.

CR:      Yes, the studies have methodological problems. It’s hard to do studies on drug users and their cognitive deficits. Hard to get a control group, hard to know how much people are using, and how long – who can really keep track of that kind of thing, when they’re either high or coming off a high? Hard to get a pre and post group. So the studies are flawed. But not in the direction you’re thinking. If anything, the drugs do more damage than what the studies suggest.

SH:      How so?

CR:      Well, cognitive functioning is only one aspect of what drugs do to the mind. You already know about the neuropathy. But there’s also the emotional piece, which most of the studies don’t even begin to measure.

SH:      So you’re going to convince me to stop using drugs so that my feelings don’t get hurt? Nice try, Carola, but that is even more ridiculous.

CR:      I’m not going to try to convince you of anything. I’m going to try to find that small part of you that wants to change, and work _with_ you.

SH:      So trite.

CR:      …

SH:      …

CR:      The motor skills—

SH:      I want to play the violin again. _Really_ play it, I mean. Not just ‘Air on the G string’.

CR:      That’s what I mean.

SH:      What?

CR:      The part of you that wants to change, that chose to be here.

SH:      Let’s just get on with it, shall we?

CR:      …

SH:      …

CR:      When did you first start to use cocaine? Do you remember the first time?

SH:      I fail to see the relevance.

CR:      Do you remember the first time? Have you forgotten?

SH:      Are you implying that my memory is gone? Of course I remember the first time! Every addict remembers the first time.

CR:      Well, I’d like to hear about it. Tell it to me like a story. How old you were, where were you living, what were you doing with your life at the time.

SH:      I was 18. First term, my second year.

CR:      Where were you living?

SH:      In my college rooms. Trinity. There was a party in Emmanuel. Victor – my lab partner – suggested we go. I didn’t want to go, knew it would be a lot of ‘rah rah rah, aren’t we clever people’ and other self-congratulatory banter. But I went. And someone who Victor knew had some cocaine, powder.

CR:      Had you ever thought about using cocaine before that time?

SH:     What? No, no, of course not. I thought all drug users were idiots, junkies, worthless. And I hadn’t a clue where to get the stuff, even if I’d wanted to. I wasn’t _that_ kind of person, I thought. But it was the beginning of the term – new term, new chance, right? Chance to get things right.

CR:      How had your first year been?

SH:      No more wretched than anyone else’s. At least until I met Victor.

CR:      Your lab partner.

SH:      My – _friend._ Look, things with Victor – I don’t want to talk about Victor any more than I have to. Suffice it to say, he was my friend first, and then we shagged. More than once. It helped if he was high, put him in the mood. So I got high, too. That’s what the cocaine was for at first. Deniability of what we had done.

CR:      The cocaine was so that you could get high with Victor and have sex?

SH:      At first, yes. So he would think I was as out of it as he was. But I wasn’t. I would have had sex with him in any state.

CR:      …

SH:      I can assure you, it was consensual. And even if it started when we were high, there were plenty of nights when he stopped by my rooms and he was clean.

CR:      So the deniability…?

SH:      Stopped being an issue once Victor found a girlfriend.

CR:      He stopped seeing you?

SH:      No.

CR:      Then…? Can you tell me more? I’m not sure I understand.

SH:      He kept seeing me, the nights he didn’t see her. She didn’t know about me, and he made sure that no one else did, either.

CR:      How did you feel about that, at the time?

SH:      I thought he was fooling himself. But _I_ was the one who was being fooled.

CR:      And?

SH:      I swore I’d never let that happen again.

CR:      …

SH:      Be fucked by a coward who was too afraid to admit what he really was.

CR:      Ah.

SH:      The drugs are still part of this story, in case you were wondering.

CR:      No, I can imagine how they might be.

SH:      They made it seem as if what we were doing was…accidental. Not important, at first.

CR:      And later?

SH:      They took on their own importance, especially when Victor left.

CR:      Left?

SH:      He was a year older. When he graduated, and moved to London with his girlfriend.

CR:      That must have hurt.

SH:      Did it hurt? I don’t know if it did, because that’s when I became an opium-eater.

CR:      You used it for…?

  1. SH:      To become lost.          



CR:      Interesting choice of words.

SH:      Yes, to lose myself.

CR:      Where? In what?

SH:      To get outside of myself. That is what it feels like, to take heroin. Not that I _was_ myself when using cocaine, that’s not what I mean. Both drugs took me far, far away, but in opposite directions. One to go up and out, the other to go down and away. Rather like Alice and the cakes that said ‘Eat me.’ I learned to modulate my moods, to temper my tantrums, if you will.

CR:      If I remember my Alice, she had a bit of a problem with knowing how much to take. Alice-the-size-of-a-house, and all that. Did you ever overdo it?

SH:      Overdose, you mean? Obviously. It takes every user a while to learn how much the body can take, what dosage and frequency. But I studied organic chemistry, remember? I understood the principles of titration, tolerance, withdrawal. Trial and error was too tedious. So I measured my own reactions, charted them in the first few months. It was an experiment until then it wasn’t.

CR:      Sherlock. I think you know exactly why you are using.

SH:      Are you being sarcastic?

CR:      I’m not. You know why you are using, and you have explained it to me in a very concise and articulate way.

SH:      Summary?

CR:      It sounds to me like you began to use drugs at a time when you were uncertain about your relationships with others – with Victor, maybe with other students at Cambridge – and the drugs at first provided you with a way to be closer to Victor. I don’t know what else they did, perhaps made you more confident? More sociable? That can happen, with cocaine.

SH:      Yes, that too.

CR:      And then cocaine became tied up with sex, and Victor, and your feeling out-of-control.

SH:      I never said that I was out of control.

CR:      You couldn’t control Victor.

SH:      Did I say that I was trying to?

CR:      He wanted you, but not enough. And didn’t you want something different from him? More, I mean?

SH:      Yes, but that’s not the same as controlling someone.

CR:      Technically, no. And I’m sorry I used that term. It probably sounded patronising, didn’t it?

SH:      You said it, not I. But yes. Everyone wants control in their lives. I don’t see why it’s pathological just because I’m an addict.

CR:      That’s a good point.

SH:      But you were right, about the drugs getting tied up with how I felt about Victor. And with sex, too. Cocaine is a stimulant, helps with endurance. It became hard to –

CR:      Hard to have sex without the drug?

SH:      Yes. Though I’m not sure if that was a physiological or a psychological response.

CR:      How so?

SH:      If I formed an association between sex and cocaine and that’s why I didn’t want to have sex when I was off the drugs, or if my body really _needed_ the drugs to get it up.

CR:      It could have been both. And maybe it’s not important which one it was, once the connection was formed.

SH:      Sex, drugs, and Rachmaninoff.

CR:      Was that how it was, for you?

SH:      Cocaine sped up my reflexes, which was very useful for playing the fast passages in Paganini at least.

CR:      You’re incredible.

SH:      What?

CR:      Your sense of humour.

SH:      That was not a particularly funny joke. It was a _pun,_ Carola.

CR:      A lower form of humour?

SH:      Exactly.

CR:      Humour is a form of resilience. A way to look painful truths in the face and not to flinch.

SH:      Is that what it is, then? I thought it was a form of cruelty.

CR:      That you direct at yourself?

SH:      …

CR:      Truth is painful. But humour can temper the pain. – Not like the drugs temper your moods, but similar. I’d rather have you use humour, any kind of humour, than use drugs.

SH:      Gallows humour.

CR:      What about it?

SH:      That’s what I like.

CR:      I can tell. It’s not so uncommon in my profession, either.

SH:      …

CR:      …

SH:      So that’s it, then?

CR:      Yes.

 

 

 

**Notes for the Chapter:**

> Hey! I've loved your questions and observations about Sherlock and mental illness. If you have any specific topics that you'd like me to write about in more depth on my tumblr, please let me know!


	19. Letters and Other Correspondence

____________________________________

15 June 2002

Mycroft –

I have been informed that you have called several times to ask the office staff here when I am going to be discharged.

First, for someone who professes to love law and order, you are showing a shocking disregard for the policies of Blakely House. As you know, Blakely House cannot release information about patients to outsiders, no matter how much a ‘loved one’ professes to care about a patient’s wellbeing, no matter how much influence the ‘loved one’ has at the Home Office.

Second, I’ll get in touch with you once I’ve sufficiently recovered from a lifetime of being lied to, spied upon, manipulated, and exposed. Therapy is supposed to be helpful in this regard; at least, you had better hope that it is helpful, if you want me to write to you again.

In other words, get out of my life and stay out if you ever want to meet with me outside of a barrister’s office.

Most sincerely,

Sherlock Holmes

___________________________

17.6.02

Sherlock:

Very well. As you wish.

I must ask: What are the terms of this self-imposed isolation? Must I contact your barrister before I can meet with you? Or may I send correspondence to you directly?

I must admit, though, this is rather tedious. And as this may be the last time that I write to you, there are a number of things that I think you should hear.

The thing I’ve always despised about therapy – necessarily evil though it is – is the assumption that all problems stem from childhood trauma, when we both know how fickle one’s memories can be. Eyewitness testimony? Utter rubbish, completely unreliable. A witness will call anyone guilty, so long as he’s part of a police line-up. Not to mention how suggestible humans are, most of the time. I think that you and I can at least agree that memory is a flawed record of the past. Take our childhoods, for instance. You say that I was father’s favourite; I’ll insist, as I always have, that he was impartial, a man of logic. Mummy and Abuela, on the other hand – so emotional, so attached to people and things. They had their protégés, their protegidos, as you would say. And you were their golden boy, more so even than any of Mother's students (though that was before your time). But see how our memories deceive us? See how you and I lived through the same childhood, and yet remember it so differently?

Really, Sherlock, I have more than forgiven you for your atrocious childhood behaviour – the tantrums, the showing off, the tattling to Mummy -- and I think it’s high time you do the same for me. I understand that it’s perfectly natural for a ten-year-old to despise his older brother, especially when the difference in age led to me developing my talents so far ahead of yours. You couldn’t help but feel envious, inferior, wronged. But you’re a man now, Sherlock. Time to put childish things behind. We don’t all have the luxury to wallow in the wrongs done to us as children. Some of us have occupations, families, hobbies to attend to. It would serve you well to develop some of your own – a job, for instance, now that would be novel, wouldn’t it? – and to stop stewing over the ways that I have supposedly wronged you.

Please don’t take this the wrong way, Sherlock. I have only your best interests at heart. You know that you may contact me at any time, day or night, whenever you are ready to get serious about being an adult.

In the meanwhile, you may find the enclosed job postings of interest to you. I think you would make the ideal forensic scientist, with your chemistry background and your interest in crime.

Your loving brother,

Mycroft

 ____________________________

20 June 2002

Mycroft:

The irony of you quoting from Corinthians is not lost on me.

To paraphrase:

‘Though I speak with the tongues of men and of angels, and have not love, I am nothing.’

As I have mentioned before, I am not interested in obtaining employment by nepotistic means.

Please direct all future correspondence to my legal representative, Mr James Tierney, Esq. I believe you have his firm’s address.

~SH

_____________________________

20.6.2002

Sherlock:

I hope this letter gets to you in time before you leave Blakely House, but I called them on the telephone and they said that they’d forward it to you in case you’d already left.

I wish I felt good enough to make the trip down to London to see you. So let me repeat my invitation for you to come and stay with me in Edinburgh.

Mycroft called me several times this week. He says that you don’t want to see him. I can’t say that I blame you, but would you at least get in touch with him so that he stops pestering me? I think he knows that you’ve been writing to me – don’t ask him how he knows, I’m sure he would deny it, and I didn’t say anything about it – and he was trying to pump me for information about you. I told him that I hadn’t seen you in three years (YES!! It has been that long. High time you get your arse up to Edinburgh, Sherlock!) and that he should try to talk to you once you’re out of rehab. Maybe you don’t want to talk to him, Sherlock, but he is your brother, not mine.

Anyway, I’ve been thinking about your portrait. I want to paint you before I die. So hurry up to Scotia, dear boy, and I’ll render you in the Death and the Virgin piece that I have in mind. And no, Sherlock, before you ask me which one you’re posing for, let me give you a hint: it’s the figure who isn’t a skeleton. So you had better put a little fat on your bones.

Kisses,

Georgie

_______________________________

 

From: Jemima Harris <jfh23@homeoffice.gov.uk>

Date: Mon, 17 June 2002 at 12:02

Subject: Referral for forensic scientist

To: Cmdr. Gibbons <fpgibbons@met.police.uk>

 

Commander Gibbons:

I am writing on behalf of Alistair Arbuthnot, Deputy Minister of State for Crime Prevention and Antisocial Behaviour Reduction at the Home Office. We would like to recommend an individual for employment as a forensic specialist in the Homicide and Serious Crimes Command. Mr Sherlock Holmes has a PhD in organic chemistry from Cambridge University, where he received commendations for his doctoral dissertation on ‘Exogenous neurotoxins, metalloproteins, and haemoglobin analysis.’ His vita is attached.

Deputy Minister Arbuthnot has known Mr Holmes in a personal capacity for many years and can vouch for his character and professional skills.

Please contact me or Secretary Arbuthnot if you have any questions about the qualifications of this candidate.

Sincerely,

Jemima Harris

Personal Assistant to Secretary Alistair Arbuthnot

Deputy Minister of State for Crime Prevention and Antisocial Behaviour Reduction

The Home Office

_______________________________________

 

On Mon, 17 June 2002 at 15:01, Commander Gibbons <fpgibbons@met.police.uk> wrote:

Greg:

See attached email from Jemima Harris at the Home Office.

What do you make of it?

~Pete

\--Message attached--

_______________________________________

 

On Mon, 17 June 2002 at 15:33, Detective Sgt Lestrade <glestrade@met.police.uk> wrote:

Pete:

Is this some kind of joke? They’re recommending Sherlock Holmes for employment here?

LMFAO.

~Greg.

________________________________________

 

On Mon, 17 June 2002 at 15:33, Commander Gibbons <fpgibbons@met.police.uk> wrote:

Greg:

Unfortunately the email is legitimate. I just got off the phone with Secretary Arbuthnot himself.

I told him that we are not hiring at the moment, nor in the foreseeable future.

No, we haven’t filled the position. But we’re not hiring Holmes.

I’d like you to look at the vitas of the following applicants before tomorrow. You’ll be talking to each of them after I interview them individually.

  * Joshua Bernstein
  * Amanda Clyburn-Smith
  * Herbert Anderson
  * J. J. Barnes (no first name given)



Thanks, Greg.

Pete

____________________________________

 

On Tuesday, 18 June 2002, Detective Sgt Lestrade <glestrade@met.police.uk> wrote:

Pete:

I left the evaluation forms for the job candidates on your desk.

Let me know when you’d like to discuss them.

~GL

______________________________________

 

From: Commander Gibbons <fpgibbons@met.police.uk>

Date: Thursday, 20 June 2002

Subject: forensic scientist position

To: Herbert Anderson <HerbA@yahoo.com>

Cc: Detective Sgt Lestrade <glestrade@met.police.uk>, Julian Downer <jdowner@metpolice.uk>

 

Mr. Anderson:

I am very pleased to offer you a position as a forensic scientist for the Homicide and Serious Crimes Command of the Metropolitan Police of London. Detective Sergeant Gregory Lestrade will be your immediate supervisor; he has been sent a copy of this email.

We were very impressed with your credentials and hope that you will decide to join ‘Team Homicide’.

If you wish to accept this position, please response to us via email or telephone within the next seven days.

Salary and benefits will be consistent with what we discussed at your interview on Tuesday; Metropolitan Police pay grades are commensurate with experience, education, and years of service. For further information, please contact my secretary, Julian Downer.

Awaiting your response,

Temporary Commander F. Peter Gibbons

Metropolitan Police of London

Homicide and Serious Crimes Command

Specialist Casework Investigations Team

____________________________________

23 June 2002

Georgie:

Very well. I will come to Edinburgh to visit you. The portrait you describe sounds tolerable, but the fact that you think I would make a good Virgin is somewhat risible. I think I would prefer to play Death.

Do they still put lead in oil paints? Some believe Van Gogh accidently killed himself by licking his paint-covered fingers a few too many times. Either that, it was suicide. I’m waiting for them to exhume his body so we can discover the probable cause of death.

I hope that you wash your hands well after you paint and that you work in a well-ventilated room.

Do you even have an air vent in your flat? Large or small? Or a chimney? They’ll suffice for air circulation.

Shall we play a game, then? I’ll come visit you, but won’t tell you when. You always liked my puzzles.

~SH

**Notes for the Chapter:**

> I have had some very rich conversations lately about psychopathology, Sherlock, and the poetics of disciplinary language. Thank you, aderyn, chapbook (songstersmiscellany), afrogeekgoddess, roane72, professorfangirl, and everyone else who has left comments for me lately and who has been in touch. 
> 
> I know that this fic is getting long, and for some readers that is a good thing, but others may have jumped ship at this point. So -- let me say that this has been the most rewarding piece of fiction that I have ever written, both because it is a subject matter that I am passionate about, and because of the interest and curiosity that many of you have shown towards the idea of Sherlock in therapy. So thank you, so very much, for your patience as this story slowly unfolds. It is a blessing to have such readers!
> 
> ~Emma


	20. Session No. 11

**Notes for the Chapter:**

> "The patient comes to treatment with assumptions about the doctor, and the doctor with assumptions about the patient. These assumptions sometimes doom the treatment before it begins. The most noxious assumption that doctors can fulfill is the feeling by patients that we, their doctors, represent the “system,” the status quo of power and privilege. We will label the patient as sick, and then send him through a rigamarole of diagnosis and treatment that will end up with his extrusion as a “patient,” often without an active and productive role in society or a strong sense of self-worth. The resistance of patients to treatment is often a reflection of their justifiable, if sometimes exaggerated, hesitation to enter this process.
> 
> Harry Stack Sullivan (1954) taught us that sometimes, contrary to our comments on the encounter, it is better to avoid conflict with patients, especially if they want it. If patients expect us to confront them, we should agree with them instead. In so doing, we are disabusing patients of their assumptions about us and removing such distortions from the interpersonal field, again in the interest of real valid relationship-building.
> 
> The basic idea of this counterprojective position is that sharing feelings reduces them.”
> 
> — Havens, L.L, and Ghaemi, S.N. (2005). Existential Despair and Bipolar Disorder: The Therapeutic Alliance as a Mood Stabilizer. American Journal of Psychotherapy, 59(2), 137-147.

_Confidential. For training purposes only. Do not circulate._

Date: Friday, 21.6.2002 11a.m.

Psychologist: Dr Carola Rivas, PhD

Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 11.

_________________________

CR:      Good morning, Sherlock.

SH:      Carola.

CR:      …

SH:      It’s that time of the week again.

CR:      What time?

SH:      When I come and pour my heart out to you.

CR:      Is that what you’ve been doing?

SH:      …

CR:      Why the face?

SH:      I still can’t get over the fact that I’m doing this.

CR:      Doing therapy?

SH:      Yes.

CR:      Why does it seem odd to you?

SH:      …

CR:      I can’t tell what you mean just by your expression. You have to tell me what you’re thinking.

SH:      I swore I’d never do it again. Therapy, I mean.

CR:      When was that?

SH:      When I fired the last therapist. Let’s see, about ten years ago, now? Yes, ten years ago.

CR:      You were very young then.

SH:      What difference does that make?

CR:      I imagine a lot has changed in your life.

SH:      Obviously.

CR:      And why were you in therapy before? How did you understand it?

SH:      I didn’t understand it at all.

CR:      What were _you_ told? – about why you were sent to therapy?

SH:      Do I really have to explain to you? Can’t you guess?

CR:      No, I can’t guess, Sherlock. There are so many reasons why parents decide to put their children in therapy. Because it wasn’t your choice, was it, Sherlock? Not at that age.

SH:      Of course it wasn’t my choice! I was twelve years old. ‘Poor socialization,’ is what they said. Or grief. Or – being English? Suspicions of buggery? I don’t know why.

CR:      Who said?

SH:      My teachers, in Germany.

CR:      Oh yes, you went to school in Germany.

SH:      My mother died and I was exiled to Germany.

CR:      Is that how you see it?

SH:      It is how I _see_ it now and how I _saw_ it then. I knew what it was, what he was doing.

CR:      Who? What was who doing?

SH:      My father, sending me away. Very convenient, too, with my brother away at university and my mother dead. Get rid of the youngest son. So Brothers Grimm, isn’t it? Not to mention, the proximity to the Black Forest. Heidelberg, I mean, where I went to gymnasium.

CR:      You sound – sad? Disappointed?

SH:      Resentful, Dr Rivas. I am _resentful._ Not disappointed.

CR:      Why were you sent to Germany? Weren’t there schools here that would have been appropriate?

SH:      My father spoke five languages. He wanted me, at a minimum, to speak that number. I haven’t disappointed him, either, in that regard.

CR:      Oh?

SH:      English, clearly. Spanish. German. Swedish, which means I can understand Danish and Norwegian, too. Portuguese, Italian, French – the other Romance languages came easily, after the Spanish.

CR:      Very accomplished.

SH:      But you knew that, doctor.

CR:      …

SH:      You are a polyglot as well, I presume?

CR:      What does this have to do with your being in therapy before?

SH:      I’ve been trying to deduce your accent, your parents’ accents.

CR:      Can this wait?

SH:      Can it wait? Of course it can wait, if you have _more important_ things to ask me about.

CR:      We can talk about my accent later. Was your first therapy in English or German?

SH:      English, at first. Then a mixture. It’s not hard to find an English-speaking therapist in Heidelberg, what with the proportion of academic types in that town.

CR:      So your father sent you away to Germany. And did you start in therapy right away?

SH:      No. Not until I developed ‘problems’ in gymnasium.

CR:      What kind of problems?

SH:      I thought I mentioned them before.

CR:      You mentioned, when we did that first interview, that you had been teased. You didn’t say why. And the cigarette burns?

SH:      Which point do you want me to explain first?

CR:      Whichever you feel is most relevant.

SH:      I was the new boy. That should be enough, in most cases. But there was more, of _course_ there was more. Let’s see – I came to Heidelberg not knowing a word of German, and within six months I was getting the best marks in German literature of any of the students; mathematics and science were a given, but the German surprised them. Strike one against me. Strike two: I was twelve years old and 175 centimeters tall, 53 kilos. A scarecrow, a skeleton, or what-have-you. You’ll be pleased to know that my attenuated figure is not entirely a result of my drug use. Genetics _did_ have something to do with it. Strike three: I preferred chemistry and Mozart to football and almost anything else that interested them. And they said that _I_ needed therapy, when _they_ were the ones who attacked me.

CR:      You were the new boy, and you were smarter than the rest and rather – tall and thin?

SH:      That’s a kind way to put it. I was ungainly, uncoordinated, constantly tripping over things – oh, I know you wouldn’t believe it to look at me now, but believe me, it took years of practice in the martial arts to learn not to trip over my own feet.

CR:      Did you learn martial arts to protect yourself?

SH:      Naturally. Boys are vicious, relentless creatures.

CR:      Thus the burns.

SH:      They caught me smoking one day. Convenient, the live cigarette.

CR:      …

SH:      Or not so convenient, as the case may be. You have seen my arm.

CR:      Indeed.

SH:      Does it shock you?

CR:      Do you want it to shock me?

SH:      If you found this shocking, then I would seriously doubt your level of experience. Humans are cruel. Surely you know this by now.

CR:      So you are testing me, then? Trying to see what shocks me?

SH:      I test everyone I know. Only way to know who’s safe and who’s not.

CR:      I might be dangerous, then?

SH:      You might be. I have to wonder what kind of people are attracted to psychology, in the first place.

CR:      …

SH:      There’s a kind of voyeuristic pleasure, isn’t there, in hearing others’ stories? In knowing things that others don’t know?

CR:      Is that how _you_ feel, Sherlock?

SH:      I’m not a psychologist.

CR:      But you observe things about people, things that other people don’t see.

SH:      I’ve always been like that. It doesn’t make me a psychologist.

CR:      Does it make you a voyeur?

SH:      A voyeur? No. I always thought of Mycroft as the one who got off on watching others. Not I.

CR:      So your observations--?

SH:      Come later. After the fact. After the _act,_ I should say. I see where people have _been_ , not where they are – well, I see where they are too, but it’s not nearly so interesting, because I’m there, too, in most cases. But I would rather piece together what has already happened, than watch it in the act. Watching life unfurl is tedious; it takes too long.

CR:      Why do you think you see more than others?

SH:      I think – That’s the advantage of growing up between places – England, Spain, Germany. You learn to notice things that others don’t see, learn to see what happened before you got there to make a place the way it is. In Spain, Franco: the silences, the paranoia, the fear. In Germany, the fear of one’s worst, of what could happen if the Third Reich – Fourth Reich – should come again. And England – the periphery taking back the metropolis, you see it in London’s dwellers, you see where England has left her mark, see where she is now. Pakistan, India, South Africa, the West Indies. Afghanistan, too.

CR:      You seem to know a lot about the world.

SH:      About Europe, I know quite a bit. But Europe isn’t the world. I know enough to know that.

CR:      It sounds to me like you’re describing what it’s like to be between places, to never quite have a place of your own.

SH:      I’m not quite homeless yet.

CR:      I’m confused. Wasn’t there some trouble with your flat? You mentioned something, when you came in, about not having a fixed residence? Unless I’m remembering incorrectly.

SH:      I didn’t say that I was _without_ residence. I said that I didn’t have a _fixed_ residence. I go between Cambridge and my flat in London. Not to mention the occasional night in one of my foxholes. Don’t look puzzled, they’re just rooms that I keep. In various locales in London.

CR:      So you have a flat?

SH:      Yes, I have a flat. I’m the son of a viscount; of _course_ I’ve got a flat. We haven’t entirely eliminated the privileges of the peerage in England, now have we?

CR:      But it bothered you that I might think otherwise. That I might think you were homeless.

SH:      I may be an addict, but I’m not _that_ far gone. I inherited some money from my parents. And I haven’t spent it _all_ on drugs.

CR:      Did I suggest you had?

SH:      That’s what my father thought. That’s why he made Mycroft the executor of the will; he thought that I had spent all of my allowance on drugs.

CR:      And had you?

SH:      I had to equip my laboratory, you see. It doesn’t do to skimp where a ventilator is concerned, unless you’re trying to asphyxiate yourself. And I can assure you, I don’t have a death wish. But Mycroft said that I was using, and my father believed him.

CR:      Why would he believe Mycroft’s word over yours?

SH:      You wonder at that? Really, have you been listening to me _at all_?

CR:      I –

SH:      Of course he would believe Mycroft’s word over mine.

CR:      I’m sorry.

SH:      What for?

CR:      That you thought I wasn’t listening to you. Because sometimes, when I ask a question, it’s not that I don’t believe you or that I’m not listening. It’s because I want to hear more, from _you._

SH:      I’m not a liar. That’s the problem. He would have liked me, if I’d been willing to lie.

CR:      About what? What would you lie about?

SH:      My mother.

CR:      …

SH:      …

CR:      You like to leave me hanging, don’t you?

SH:      Not at all. I would have thought it was obvious. I knew things about my mother that my father didn’t want known.

CR:      What kinds of things?

SH:      I’m sure you can imagine.

CR:      You’re doing it again.

SH:      Doing what?

CR:      Not telling me directly.

SH:      Must I spell everything out for you?

CR:      Yes.

SH:      My mother was – _attached_ – to one of her students.

CR:      Meaning?

SH:      …

CR:      Sherlock?

SH:      …

CR:      It’s difficult to say it, isn’t it? She died when you were so young.

SH:      …

CR:      No one wants a parent to—

SH:      Shut up! I can’t _think_ with you going on like that.

CR:      …

SH:      …

CR:      I was going to say: you must have loved her very much.

SH:      …

CR:      …

SH:      How do you know that?

CR:      Because it pains you to say anything bad about her.

SH:      I wouldn’t be sullying her name, if that’s what you think I’m worried about. She was blameless. It was my father who was at fault.

CR:      Yes, you have said that before.

SH:      It was his fault that she was – _unhappy_ , I suppose is what you’d call it.

CR:      …

SH:      He was – not good to her. I don’t blame her, for looking elsewhere.

CR:      Did he blame her?

SH:      Yes. He wasn’t one for clemency, was Sigur.

CR:      He sounds like rather a harsh person.

SH:      Does he? I suppose he was.

CR:      I feel like we’re getting at something important here, Sherlock. I want to hear more, about your mother’s death, about your father, about what happened to them and to you. But I’m looking at the clock, and I see that we only have a minute left. So I’ll just ask you: what is it like to talk to me about this?

SH:      What is it _like_? I’ve never done it before. I can’t really compare it to anything.

CR:      You’ve never talked about your mother’s death? What about when you were in therapy the first time?

SH:      I was young. And yes, we talked about it. But the therapist thought I was exaggerating.

CR:      The therapist didn’t believe you, either?

SH:      No. You know who my father was.

CR:      Yes. And his word--?

SH:      Worth more than a 12-year-old’s.

CR:      You’ll tell me what happened?

SH:      To my mother? Yes.

CR:      See you Monday, then.

SH:      One more thing. Your accent. Rivas could be Spanish, could be Eastern European. But your vowels are a bit long, especially the ‘I’s and ‘E’s. Parents who didn’t speak English at home, then. So I’d say – Spanish or Latin American. Dark hair, curly, skin that tans easily – European and African descent? Or Mediterranean. Mostly European, in any case. But you don’t seem to be familiar with Spain. So – Caribbean? Peruvian? But with an interest in psychoanalysis. Argentinian? No, they sent all their slaves to war, to die. Unless—

CR:      Uruguayan.

SH:      You answer me at last. Damn. How could I have forgotten Uruguay?

CR:      It’s a small country.

SH:      Still, I should have realized. River Plate basin, history of slavery, importation of psychoanalysis.

CR:      Is that all?

SH:      You’re irritated with me.

CR:      Yes.

SH:      It’s not so much fun being analysed, is it?

CR:      Good-bye, Sherlock. I will see you on Monday.

SH:      Good-bye.

 

 

 

 

 

 

**Notes for the Chapter:**

> I have now started a complementary story to this one, 'That Obscure Object,' which is about John and his experiences with trauma. 
> 
> A number of you asked me if I would tell John's story next, and ChapBook gave me a prompt to talk about 'John and Ella and trust issues,' so another fic emerged. My priority is to finish 'In Confidence' first, but I spent some time this week putting down John's story before it got away from me. More psychology there, too, for those who like it.


	21. Session No. 12

**Notes for the Chapter:**

> A few notes on truth and narrative in psychotherapy:
> 
> A question that often comes up when working with patients in psychotherapy is, Did this story really happen the way that the patient is describing it? And, if not, how and why is the discrepancy important?
> 
> We are all of us unreliable narrators of our own lives, as anyone who has argued with a parent or sibling over the sequence or content of past events can attest to. In therapy, it may not always be possible to consult family members or friends of the patient to find out ‘what really happened,’ whether because such individuals are unavailable (dead or absent), or the patient does not want the therapist to correspond with others in his life. Even if such individuals are available, a further question that may arise is whether or not their narrative is any more ‘truthful’ than the patient’s.
> 
> Many arguments have been had over whether or not childhood traumata ‘really’ existed in specific cases (see, for example, Judith Herman’s book, Trauma and Recovery for a thorough discussion of trauma, childhood memories, and Freud’s renunciation of his theory of the origins of hysteria in childhood sexual abuse). Of course, there are events that happen that cannot be explained away by differing points of view. And when these events can be pinned down, all the better. However, family secrets are often exactly that -- secrets -- and the truth of them is harder to determine. 
> 
> The inconsistencies in one’s narrative are places that a therapist (at least one who is trained psychodynamically) is trained to look for, the knots in an otherwise smoothly woven story. Such inconsistencies do not necessarily mean that the patient is a liar; instead, they point to the places where some of the most fruitful therapeutic work can happen.

Confidential. For training purposes only. Do not circulate.  
Date: Monday, 24.6.2002 11a.m.  
Psychologist: Dr Carola Rivas, PhD  
Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 12.

__________________________________

Carola Rivas: Good morning.

Sherlock Holmes: Good morning.

CR:  I sensed that there was something very important that you were going to tell me last time.

SH:  …  


CR:  What is that face?  


SH:  You can go ahead and ask me outright, you know. I’m not going to fall apart just because you ask me about my mother’s death.  


CR:  What should I know about it?  


SH:  I told you that I blame my father.  


CR:  Yes. He was driving the car, was’t he?  


SH:  Yes. He’d been drinking – everyone had been drinking. New Year’s Eve.  


CR:  …  


SH:  I was the one who got the call to go down to the police station. But I’ve told you this before.  


CR:  You picked up the phone.  


SH:  They thought I was Mycroft.  


CR:  Why did you go down there alone? Wasn’t there anyone who could go down there with you?  


SH:  You mean my nanny, perhaps? Or the housekeeper?  


CR:  Someone like that. Or Mycroft.  


SH:  I wanted to see for myself. I didn’t want them telling me what had happened, lying to me like a child.  


CR:  Why would they lie to you?  


SH:  Because no one ever tells children the truth. As if I didn’t know what was happening between my father and my mother.  


CR:  Which was…?  


SH:  They were –  _estranged_. He was living in Sussex, she was in London.  


CR:  How did they explain that to you? Their separation, I mean.  


SH:  They said that Mummy needed to be in London to concentrate on her musical career.  


CR:  Sussex is not that far from London. Plenty of people live here and work in London. Couldn’t your mother have done the same? Travelled to the city when she needed to?  


SH:  Now you see why I was suspicious.  


CR:  And where were you living at the time?  


SH:  With my father. I went to a local day school. My mother came back on Tuesdays, then returned to London Friday morning for weekend rehearsals, concerts. A musical career is not very amenable to family life.  


CR:  I can see how this might be – confusing, perhaps? You knew something else was going on, and no one would talk to you about it? Or did they?  


SH:  No.  


CR:  What about Mycroft?  


SH:  He was at uni.  


CR:  What did  _you_ think was going on with your parents?  


SH:  I thought my father was angry.  


CR:  …  


SH:  At me.  


CR:  At  _you_ ? Why?  


SH:  Because he never liked me.  


CR:  Why wouldn’t he like you?  


SH:  If I am not an agreeable person at present, you can hardly believe me to have been at twelve years old.  


CR:  Few children are, at that age.  


SH:  He sent her away.  


CR:  He _sent_ her away?  


SH:  She wouldn’t have gone on her own.  


CR:  So…I don’t know very much about your parents, but didn’t your mother have a say in the matter?  


SH:  He made her miserable.  


CR:  What do you mean by that, exactly?  


SH:  Must I really tell you every excruciating detail? The crying spells, the arguments, the sudden departures for London?  


CR:  So she left?  


SH:  It was _his_ fault.  


CR:  …  


SH:  Do you doubt me?  


CR:  I don’t doubt that you felt that it happened that way. But I am still confused.  


SH:  Really? I would have thought that a psychologist would know to expect crimes of passion.  


CR:  What was the crime?  


SH:  Her death.  


CR:  I still don’t understand. You said your father was to blame. He was driving the car. Was it an accident?  


SH:  You don’t think I would tell you if I had figured it out? Ha! I wouldn’t keep it a secret if I had.  


CR:  …  


SH:  That’s exactly the problem. I don’t know  _how_ it happened. But it did. Murder, man-slaughter, death by slow exhaustion and helplessness – he was responsible.  


CR:  …  


SH:  How do I know, you persist in asking me. I can see it in your face. You want to disprove me of my conviction that he was responsible.  


CR:  …  


SH:  Mycroft has tried for thirteen years and I assure you, if he hasn’t got anywhere, you are unlikely to, either.  


CR:  Tried what?  


SH:  Tried to convince me it was all in my imagination. But I  _didn’t_ imagine it. I heard what he said to her. I’ve read the police files. He was clever, though.  


CR:  What did he say to her?  


SH:  That she would have to take responsibility for what she had done.  


CR:  Meaning?  


SH:  Don’t be so obtuse! For the affair she was having.  


CR:  I’m afraid I don’t see the connection.  


SH:  I heard them fighting on Boxing Day. They were still keeping up the pretense of things being fine. Mycroft was home for the December holidays; he didn’t see what I had seen all that autumn.  


CR:  …  


SH:  The fights. The flights. Violeta leaving for the train station, suit-case in hand. Saying good-bye to me. Telling me – telling me –  


CR:  What? What did she say?  


SH:  That she had a rehearsal – the Brandenburg Concertos – and would be back soon. But she didn’t  _need_ to rehearse the Brandenburgs. She wasn’t playing harpsichord anymore, in those days.  


CR:What are you saying? That she didn’t need to be there?  


SH:Obviously not. It was a ruse.  


CR:  …  


SH:  …  


CR:  Sherlock?  


SH:  …  


CR:  …  


SH:  Fuck off! I don’t have to explain  this to you, do I? Just hand me the tissues.  


CR:  …  


SH:  …

  


[Tape is silent for approx. 5 mins]

  


CR:  She never came back, did she?  


SH:  She came back on Tuesdays. I told you.  


CR:  Yes, you did. What I meant was, she never really came back to your family, did she?  


SH:  …  


CR:  …  


SH:  That much should be apparent.  


CR:  And Mycroft didn’t believe you about – about the cause of her death. How did that go?  


SH:  He told me that there was no evidence that it had been intentional.  


CR:  Was there?  


SH:  I’ve searched through every page of her file, ordered copies of the coroner’s report. There _must_ be something that I’ve overlooked!  


CR:  Sherlock.  


SH:  Carola.  


CR:  What difference does it make?  


SH:  Are you an  _idiot_ ? It makes all the difference in the world.  


CR:  Forgive me. I didn’t mean to imply that it was irrelevant. What I mean is – what difference does it make to  _you_ , whether or not it was intentional? How would that change things now?  


SH:  If he killed her, then I was right and Mycroft was wrong.  


CR:  Is that what this is about? You being right?  


SH:  Him being wrong. He is so insufferable when he thinks he is right. He’s been insufferable for thirteen years. But that’s not all of it, of course not.  


CR:  And if you prove him wrong? Then what?  


SH:  What do you mean? Then it means that I was right, all of these years. Our father murdered our mother. Mycroft was a fool, in denial.  


CR:  But you weren’t.  


SH:  They thought I was crazy, grief-stricken.  


CR:  I would have been surprised if you weren’t. Grief-stricken, I mean. Your mother had just died in a car crash – accidental or not, that was an enormous loss.  


SH:  Complicated grief reaction?  


CR:  Did someone say that’s what was happening to you?  


SH:  My first therapist.  


CR:  Could be the case. Hard to tell in retrospect.  


SH:  Memory is so deceptive, isn’t it?  


CR:  …  


SH:  Why are you looking at me like that?  


CR:  You doubt yourself. You doubt your own perceptions of what happened.  


SH:  I know what happened.  


CR:  There was no room for you to doubt yourself, because everyone else doubted you.  


SH:…  


CR:...  


SH:  What do you mean?  


CR:  They told you that you were mistaken, that it had been an accident after all, and because no one took you seriously, you had to buttress your position with arguments, facts, deductions. Because you were a child. And there was no room for the ordinary doubts that anyone would feel, the anger at the injustice of it all, because you had to work so hard to be taken seriously.  


SH:  What else could I have done?  


CR:  I don’t know that you _could_ have done anything else, being the person that you are.  


SH:  Oh, so it was all ‘destined’ to be? I can’t believe you’d think that.  


CR:  Not that it was destined. Just that –  


SH:  Yes? I’m eagerly awaiting your interpretation.  


CR:  You knew that something was wrong between your parents.  


SH:  Yes.  


CR:  That their marriage was…unhappy. But no one would say that outright to you. No one would trust you with that knowledge, even though you could see it for yourself.  


SH:  They always denied it.  


CR:  Who did?  


SH:  My mother. Father. Mycroft. Told me I was imagining things.  


CR:  But you weren’t, were you? Imagining things.  


SH:  No. I  _heard_ them. I saw her leave. Mycroft didn’t. He was at uni.  


CR:  You were the only one who was around to see what was happening.  


SH:  Yes.  


CR:  But they told you it wasn’t true.  


SH:  They lied to me.  


CR:  And you were twelve years old. Mycroft was – nineteen? And your father much older, of course.  


SH:  She was gone. She couldn’t speak for herself. And Father didn’t want to talk about her.  


CR:  What did you say to him?  


SH:  I told him he had killed her. He sent me off to Germany, for that.  


CR:  Yes, I can see how that might not have gone over so well.  


SH:   You can’t imagine.  


CR:…  


SH: …  


CR: Why are you smiling?  


SH: I was remembering something.  


CR:What?  


SH:It was when my father caught me smoking for the first time, cigarettes.   


CR:This was shortly after...?  


SH:During summer holidays, I was back in Sussex.  


CR: …  


SH: I spent an afternoon perfecting the art of the smoke ring.  


CR: Very impressive.  


SH: _How doth the little crocodile improve his shining tail. And pour the waters of the Nile, on every golden scale._   


CR: Alice!   


SH: The caterpillar, actually.   


CR: …  


SH: Why are you smiling?  


CR: You quoting Alice -- the caterpillar. And I want to hear the rest of the story, the smoke rings.  


SH: At him, of course. That’s how it ended. He found me behind the house, half-delirious with nicotine -- I hadn’t built up any kind of tolerance, back then, of course I hadn’t, I was twelve, thirteen years old! So I was strangely energetic, charged with the drug and my own conviction that _I would catch him out some day_. And when he came upon me, I told him so, told him that I knew that my mother’s death hadn’t been an accident. Told him he’d have to leave me alone, or I’d tell.  


CR: …  


SH: _How cheerfully he seems to grin, how neatly spreads his claws. And welcomes little fishes in, with gently smiling jaws...._   


CR: …  


SH: ...  


CR: What did he do?  


SH: He tried to take the ciggy from me.   


CR: And?  


SH: I blew smoke rings in his face. All that practice -- couldn’t let it go to waste.  


CR: Certainly not.  


SH: But it worked. He did leave me alone, mostly. Holding people’s secrets over their heads has that effect, generally.  


CR: What effect?  


SH: Of leaving me alone.  


CR: Is that what you want? To be left alone?  


SH: Rather that than --  


CR: …  


SH: ...  


CR: Than what?  


SH: Nevermind. But it still consumes me, sometimes.  


CR: …  


SH: I’m talking about my mother’s death now, Carola. Do keep up.  


CR: …  


SH: ...  


CR: I would be surprised if you  _didn’t_ think about it. If it  didn’t consume you, as you say.  


SH: I may never know what truly happened.   


CR: No.  


SH: And that is what bothers me the most.  


CR: The not knowing.  


SH: Yes. The not knowing. Yes.   


CR: …  


SH: …  


CR: No, you may never know.  


SH: …  


CR: …  


SH: That’s how it is, then?  


CR: …  


SH: Well, are we through?  


CR: Finished? Yes, for today.  


SH: Until Wednesday, then.  


CR: Good-bye.


	22. Session No. 13

_Confidential. For training purposes only. Do not circulate._  
Date: Monday, 26.6.2002 11a.m.  
Psychologist: Dr Carola Rivas, PhD  
Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 13.

 

Sherlock Holmes:     Do we have one more session left after today, or two?

Carola Rivas:      One today and one on Friday. You’re leaving on Monday, so there’s a discharge interview then, but that will be with Dr Franklin.

SH:       Just today and Friday. Good.

CR:      Good?

SH:       Good to know. Not good that I’m going, I didn’t mean it that way – or maybe it _is_ good that I’m going, right? That’s the whole idea of being here: to _leave._

CR:      You’re smiling.

SH:       You’re in a strange business, doctor. But I suppose my business is not much different, either.

CR:      No?

SH:       They both depend on…for lack of a better term, _bad things happening_. When it’s heaven on earth, we’ll both be out of work. Makes you wonder if we might not have a motive for keeping things in the pitiful state they’re in right now.

CR:      Your business? Not music, surely. Chemistry?

SH:       I have a hobby I’d like to make something more of, once I get out of here. And now _you’re_ the one smiling.

CR:      …

SH:       …

CR:      Tell me more. I want to hear about what you are going to do once you leave here. Tell me what you’re planning. I’m sure you’re planning to do something.

SH:       Solve crimes.

CR:      …

SH:       Don’t look at me like that! It’s something I do for fun, now and again. That’s why Mycroft has been so eager to recruit me for the SIS. That, and the chemistry background, which comes in handy in his line of work. But I’m more interested in homicide than espionage or biological warfare.

CR:      What--?

SH:       --When I say that I’m ‘interested’ in homicide, it’s like when _you_ say that you’re interested in psychopathology: not interested in _perpetuating_ it, but rather in what _causes_ it.

CR:      What _causes_ homicide? That’s what you’re interested in?

SH:       Not so much the psychological motivations, though those are important too. Dr Franklin has been most helpful in that regard, and no one can say that I haven’t made good use of my time here.

CR:      Reading about psychology, you mean.

SH:       Yes. But that’s not where my talents lie. I’ll leave that kind of work in your capable hands, Carola. No, I refer to the evidentiary trail that a murderer leaves behind: the threads caught on a nail, the dust disturbed in an empty room, the locked doors, the bruises and sores, the splatter of blood across linoleum and brick. Those kinds of things. That’s what interests me.

CR:      Forensic science.

SH:       The science of deduction.

CR:      …

SH:       That’s what I call it. Astute observation plus rudimentary logic produces extraordinary results.

CR:      …

SH:       You’ve seen for yourself. I deduced—or nearly so—where your family is from. That’s what I do. Deduce things about people.

CR:      That must be a very useful skill to have.

SH:       I tend to think so. Others, not so much. Dr Gupta, for instance.

CR:      …

SH:       I’ve had clients before, you know. This isn’t some hair-brained scheme I’ve just dreamt up while I was whiling away my time here.

CR:      …

SH:       It started when I solved a murder when I was in uni. Well, they thought it was a murder, but I was able to prove that it was an accidental poisoning. Wife of one of the lab technicians, thought her husband was having an affair, snuck into the lab and hid under a lab bench. You can only imagine what else she must have got her hands into.

CR:      …

SH:       You don’t _need_ to imagine if you don’t want to – turning a bit green around the gills, are you?

CR:      Yes. So you solved a murder that turned out to be not a murder.

SH:       Yes.

CR:      That’s pretty impressive.

SH:       No, it’s pathetic that it took the local police so long to come to the same conclusion. When _really_ – her husband worked in a lab – accidental poisoning is _always_ a possibility in these situations.

CR:      I suppose they didn’t know that she had got into the lab.

SH:       She was smart enough to sneak into the lab – husband’s ID found on her – but not smart enough to keep her hands to herself once she got in there. But, as they say, _curiosity killed the cat!_

CR:      Indeed.

SH:       What else?

CR:      What do you mean?

SH:       What else should we talk about? We’ve covered my occupation. Next?

CR:      I’m curious to know where you are planning to live once you go back.

SH:       I’m not going back.

CR:      No?

SH:       I’m not going back to London. At least not right away. Cousin’s in Edinburgh, said she could put me up for a while.

CR:      Georgiana?

SH:       Georgina. Georgie.

CR:      So you’ll be staying with her? For how long?

SH:       As long as she can stand me.

CR:      …

SH:       You and your tells.

CR:      There’s a reason Freud liked to sit behind the couch. So his patients couldn’t see his face.

SH:       There was? I don’t remember that.

CR:      You and I may have been reading for different things.

SH:       …

CR:      He felt that his face was too – responsive? That he made faces that influenced his patients in ways that he didn’t want. He wanted them to be free to say whatever they liked, without trying to please him or guess what he was thinking.

 SH:      Technique of free association.

CR:      Exactly.

SH:       But that’s not what we’re doing, now, is it?

CR:      In what sense?

SH:       This isn’t psychoanalysis. You telling me about what you’re doing, I mean.

CR:      No, I suppose it isn’t. Does that bother you? That I’m telling you about what I’m doing?

SH:       Bother me? Why would it bother me?

CR:      Well, maybe that’s not the right question. What _does_ it feel like when I talk about the process? When I call attention to what we’re doing here?

SH:       What does it _feel_ like? When you ask me the question that way, it feels fake. Like something a therapist on telly would do.

CR:      Ah.

SH:       I think I prefer you talking to me about Freud. Or when I can see your tells.

CR:      When something slips through?

SH:       Exactly. Like your expression just now, when I said that I’d stay with Georgina as long as she’d stand me.

CR:      What did I look like?

SH:       Like you doubted I’d last there long.

CR:      Is that what my face showed?

SH:       It’s what most people would think. It’s what _I_ was thinking. As I said, I’ll stay there as long as she can stand me. Might be a long time, but probably not.

CR:      But – I thought – you and she – you get along well with each other, don’t you?

SH:       As well as blood relatives can do, yes.

CR:      …

SH:       That’s not quite fair, actually.

CR:      No?

SH:       We get along a bit better than most. Or did, last time we saw each other.

CR:      So you’ll be staying with her.

SH:       Yes.

CR:      I can get you a referral to a psychiatrist and a list of methadone clinics in Edinburgh.

SH:       Thank – thank you.

CR:      And when you come back to London?

SH:       When I come back, what?

CR:      Have you thought about continuing treatment? Whether you want to, or not, I mean?

SH:       I understood that I have to continue with the methadone until the dosage is low enough for me to stop taking it altogether.

CR:      Yes. But there are psychologists in London, too. And you can keep seeing me, or Dr Franklin, or both of us, though it may be a bit inconvenient.

SH:       I –

CR:      You don’t have to decide on anything now. It’s just an idea. Because some people find it helpful, when they are transitioning back into life outside rehab, to have that support.

SH:       I suppose some people do.

CR:      You haven’t done this before, have you? The whole rehab business.

SH:       No, of course I haven’t done it before! And I don’t intend to become a revolving door patient, either, so this will be my first and last time. As educational as the experience has been.

CR:      In what sense?

SH:       I’ve learned more about psychology than what most people get from reading it at uni.

Dósis, prognosis, differential diagnosis.  
Sequelæ, traumata,  
lacunæ, stigmata.  
Pathology, nosology, complex etiology.

 

CR:      I am astonished.

SH:       It has that effect, doesn’t it?

CR:      You wrote a poem.

SH:       Hardly a _poem,_ Carola. A few bad rhymes do not a villanelle make.

CR:      You’re having fun with this.

SH:       With what?

CR:      With being here. And not just with me – here at Blakely.

SH:       Indeed?

CR:      Yes.

SH:       I’m sure it’s had its moments.

CR:      Has it?

SH:       Of course. Where else can you find such evidence of the vagaries of the human condition – the slings and arrows, la la la – if not in a psych ward? Not to mention, it’s a veritable cross-section of humanity in here – rich man, poor man, beggar man, thief. Try finding _them_ together outside of a mortuary.

CR:      Sounds like – it hasn’t been an entirely wasted five weeks, then?

SH:       When did I say that this was a waste of time?

CR:      So it hasn’t been?

SH:       No. On the contrary. It has been _most_ illuminating, doctor.

CR:      For me as well.

SH:       I imagine you don’t get many patients like me.

CR:      Like you? In what sense?

SH:       Oh, where to begin…

CR:      …

SH:       …

CR:      You can come back, you know.

SH:       I thought the whole point was to _avoid_ me coming back.

CR:      It is. I’d rather you _didn’t_ have a relapse –

SH:       Though it _would_ keep you in business?

CR:      If only I could depend on existing patients to keep my job. No, unfortunately, there are always new patients. But what I meant was – you can still see me here, if you want to come down to Surrey. I see outpatients in the afternoon. Or I can refer you to someone in London.

SH:       For more therapy, you mean?

CR:      Yes. Would that be helpful?

SH:       Not at present, as I’ll be living in Edinburgh soon, if you recall.

CR:      Well, in the case that you don’t stay in Edinburgh forever –

SH:       Not likely!

CR:      I want you to know that you can keep seeing me here. If you wish. If that’s helpful to _you._

SH:       Do you think I should?

CR:      I won’t lose my job because of lack of patients, Sherlock, so I wouldn’t want you to do it for _me_.

SH:       Ha! No danger of that.

CR:      …

SH:       …

CR:      You don’t have to make up your mind. But I’m mentioning all this because – well, I know you know this already, you’ve probably gone over it with your groups – but rehab is a strange time, a sort of retreat from things. But eventually you have to return to your own life, where the drugs might still be there. So, yes. Continuing in therapy can help. Or having a plan of some kind or another. What to do if you feel like using, that kind of thing. You’ve been meeting with a substance abuse counselor, yes?

SH:       There was nothing he told me that I hadn’t already read. But yes, I met with him.

CR:      Then you probably know all of this already. But you don’t know what it’s like to _do_ it, do you?

SH:       Do what?

CR:      Go home after rehab. You haven’t done this before.

SH:       Oh, I’ve come down from binges before, gone cold-turkey. I have some idea of what it’s like.

CR:      And how did that work?

SH:       …

CR:      …

SH:       It – didn’t.

CR:      And this time? What will be different?

SH:       I don’t want to use.

CR:      …

SH:       Before, I just wanted to stop feeling sick. Now, I want to stop using. I want to feel my fingers again.

CR:      Oh, that reminds me: how has the neuropathy been lately?

SH:       Still there.

CR:      It may take some time.

SH:       If it ever goes back to normal, you mean. I know the possible outcome. I may always have it.

CR:      Yes, you might. In any case, what I meant was – you haven’t been in rehab before, so you haven’t been discharged from rehab before. There may be things you haven’t anticipated because you haven’t experienced them before.

SH:       …

CR:      …

SH:       So this is it, then? Today and Friday?

CR:      Yes. For now.

SH:       Until we meet again.

CR:      Yes, we wouldn’t want me to lose my job.

**Notes for the Chapter:**

> I am indebted to breathedout for a fascinating discussion about Virginia Woolf and one tangent that got me thinking about the universality of suffering.


	23. Session No. 14

Session Note

Confidential. For training purposes only. Do not circulate.  
Date: Friday, 28.6.2002 11a.m.  
Psychologist: Dr Carola Rivas, PhD  
Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS. Session No. 14.

_______________________________

SH:      So this is the end, isn’t it?

CR:      ….

SH:      I suppose you’re going to say something maudlin, like ‘This isn’t the end, it’s a new beginning,’ or an equally trite aphorism.

CR:      Shall I say that? Reduce all you’ve done to an aphorism?

SH:      Obviously, I’d rather you didn’t.

CR:      You said, ‘This is the end.’ What did you mean by that?

SH:      The end of therapy.

CR:      Yes. Although I do urge you to continue when you get back to London. I’ll put in a referral for you.

SH:      What do you think I’ve done here?

CR:      I don’t understand.

SH:      You said you didn’t want to reduce what I’d done here to an aphorism. So that must mean that you think I have accomplished something while here.

CR:      Haven’t you?

SH:      You tell me.

CR:      …

SH:      Why not?

CR:      I could say any number of things, but in the end, it doesn’t matter what I think. You’re the one whose opinion matters.

SH:      That’s ridiculous. I’m the patient. You’re the doctor. I’m not in charge.

CR:      You will be, soon. –In charge. And I’m a psychologist, not a medical doctor.

SH:      I know the difference, thank you.

CR:      …

SH:      …

CR:      So…how are you feeling about leaving here?

SH:      I will ignore for the present that you have just asked me the tritest question that a therapist can ask.

CR:      And?

SH:      I don’t know what else to talk about so I may as well answer your question. I feel – I feel like I want to leave _right now,_ and not stay here over the bloody weekend! Ridiculous to make me wait until Monday.

CR:      Yes, and would it be very responsible of us to leave you to face another weekend by yourself, right away?

SH:      Weekend, weekday – what does it matter?

CR:      If it doesn’t matter, then why are you so anxious to leave?

SH:      I didn’t say I was _anxious,_ unless you meant it in the sense of _ansioso por salir,_ eager to leave.

CR:      Eager to leave, then. _Ansioso_ , not anxious.

SH:      I want to – I want to spend a few days in London before heading to Edinburgh.

CR:      What are you thinking of doing, in London?

SH:      I’ve been reading the papers – about the only reading material that changes around here – and there’s been a pair of strange murders in Kensington. I thought I might – that is – lend the police a hand. When I’m not high. To vary the experimental conditions. I’ve done it while high, --- solved a murder – and now I’m – not.

CR:      So, you’ll solve a murder to – to what, exactly? Prove that you can still do it without the drugs?

SH:      Being able to solve it isn’t the question. The issue is – is it _enough_?

CR:      Is what enough?

SH:      The thrill of the chase, my dear.

CR:      …

SH:      Oh, I know you’re not my ‘dear’. It’s a figure of speech. The question is whether the thrill of the chase measures up to the thrill of the high. I was never sure, before, if it was about the drug or about the game.

CR:      Can you tell me a little more? I’m not sure I understand.

SH:      You know I’ve had a – shall we say, _personal interest_ in murder since my mother’s…

CR:      …

SH:      …

CR:      Yes. Go on, Sherlock.

SH:      I’m interested in murder even without the cocaine. Prior to and aside from it, I mean. But when I was using, it was as if the crime was a hook and my mind got caught on it, caught up and pulled into a glorious web. And it held me up, strung out the high, until the case was over. Or – to use another metaphor – the case was like a spark, and my brain on cocaine was the tinder, and it burned so rip-roaringly, with _such brilliance,_ until the case was over. Until it burned itself out.

CR:      And after?

SH:      I solved the case.

CR:      Yes. And after that, what happened?

SH:      I don’t quite remember. I think I slept for some time. Several days, in fact.

CR:      Where?

SH:      At home, of course. At least, I woke up at home.

CR:      How many times has this happened? Have you solved a case like this, I mean?

SH:      Thrice. Three times.

CR:      Thank you, I know what thrice means.

SH:      Why you do ask?

CR:      Is that enough time to form a precedent, I wonder?

SH:      A precedent for what?

CR:      To associate the drug with the context, the crime-solving. It sounds like you think they may be related, from what you have said.

SH:      Yes, that’s exactly what I want to test out. And these murders are the perfect opportunity!

CR:      That detective who visited you here –

SH:      Lestrade.

CR:      Does he have anything to do with it?

SH:      He’s on the case, yes. Made a statement to the press.

CR:      Is he the one you’ll contact?

SH:      So glad you follow, Carola. Yes, once I get my mobile back, I’ll call him. He gave me his number.

CR:      Sounds like a plan.

SH:      I did hope you would be a bit more forthcoming about your opinion, at this stage.

CR:      …

SH:      I’m about to leave, after all. Why hold back?

CR:      Hold back what?

SH:      What you think about my crime-solving. I could see it in your face.

CR:      What was I thinking?

SH:      That I’m the oddest patient you’ve ever had.

CR:      [laughter]

SH:      Am I? Aren’t I?

CR:      Depends on what you mean by ‘odd’…

SH:      It doesn’t frighten you that I want to solve murders?

CR:      Why would that frighten me? You aren’t planning to _commit_ murder, are you?

SH:      There’s no one I care about enough to kill.

CR:      …

SH:      Was that not the right answer?

CR:      No, that’s not it. But – no, that probably _wasn’t_ the right answer!

SH:      …

CR:      …

SH:      You think I’m a psychopath.

CR:      No. No…I do _not_ think you’re a psychopath, Sherlock.

SH:      How do you know that?

CR:      You wouldn’t make that kind of joke if you were.

SH:      I might.

CR:      No, you wouldn’t. You’d be too careful to joke about murder. It’s because you _don’t_ have psychopathic tendencies that you can joke about them.

SH:      And if I’m joking about joking?

CR:      Really?

SH:      I want to know.

CR:      Has someone told you you’re a psychopath before?

SH:      …

CR:      …

SH:      He was an idiot. The term isn’t even accurate, nowadays.

CR:      No, it’s not. But it must have been hurtful, to hear someone call you that.

SH:      …

CR:      …

SH:      I suppose it was.

CR:      So, you were saying –

SH:      I wanted to know what you think of crime-solving. Of _my_ crime-solving.

CR:      Are you good at it?

SH:      To date, yes. But I have to see if I am without…you know.

CR:      Then I don’t see a problem with it.

SH:      Would there be a problem if I _weren’t_ good at it?

CR:      There would be a problem if you were getting in the way of the police doing their work. If you had a lot of theories that didn’t pan out, if you kept showing up at crime scenes wanting to help out.

SH:      If were delusional, you mean? A conspiracy theorist?

CR:      Yes, that would be a problem.

SH:      Not in my case, though.

CR:      Thank goodness.

SH:      …

CR:      Sherlock, you wanted to know my opinion?

SH:      Yes. What you really think of me.

CR:      I think you think you are worse than you really are.

SH:      I don’t understand.

CR:      You’re not a psychopath. You’re not the oddest patient I’ve ever seen. You’re not a monster.

SH:      When did I say I was?

CR:      Not in so many words. But you asked me for my opinion. And this is it: you are not a bad person.

SH:      I didn’t know you dealt in moral judgments.

CR:      Is it so hard to be told that you’re not bad?

SH:      Hard to hear? No. Unusual, yes. I have to think about it.

CR:      Maybe your cousin can help you with that.

SH:      With what?

CR:      With telling yourself that you’re not so bad.

SH:      Georgina?

CR:      She likes you, doesn’t she?

SH:      I never gave it much thought. She’s my cousin. Not my friend.

CR:      A cousin can’t be a friend, too?

SH:      …

CR:      Mycroft is a relative, too, but from what I’ve heard, you two don’t like each other very much.

SH:      Your point being?

CR:      Not all relatives are friends. In fact, in my experience, few are.

SH:      Ha!

CR:      You like that?

SH:      It fits in perfectly with my worldview.

CR:      I imagine it does.

SH:      I was thinking of seeing Mycroft. If the case isn’t too pressing.

CR:      What! When?

SH:      In London. If he’ll see me. I expect he will. He won’t know what to think, though.

CR:      How do you think he’ll react?

SH:      He’ll treat me like the prodigal son, returned. He’ll tell me that he’s ready to accept me back into the fold, provided that I’ve reformed my wicked ways.

CR:      Have you?

SH:      Depends on your definition of ‘wicked.’ I don’t want to work for him, so that tells you something.

CR:      But you’re willing to see him.

SH:      And?

CR:      Why?

SH:      Someone to torment.

CR:      Really?

SH:      That’s what you think, isn’t it?

CR:      I think…I think…You don’t have parents. Grandparents?

SH:      Abuela. Mormor. My grandmothers.

CR:      But they weren’t around to see you grow up.

SH:      Abuela was.

CR:      And where is Abuela now?

SH:      Seville.

CR:      And Mycroft?

SH:      London. This is tedious.

CR:      Mycroft knows you the best.

SH:      That’s not necessarily a point in his favor.

CR:      You grew up together.

SH:      In a manner of speaking. If this is going to turn into some lecture about the ‘ties that bind’, I can assure you, Mycroft specializes in constraint.

CR:      And yet you say that you might see him.

SH:      I have to see him about my father’s will.

CR:      I thought you had a barrister for that?

SH:      …

CR:      …

SH:      What are you implying?

CR:      I think it’s interesting that you want to see him. I don’t know what that means, and maybe you don’t, either—

SH:      Of course I know what it ‘ _means’_!

CR:      …

SH:      We’ll see if he can manage to not be an arse for once in his life.

CR:      For your sake, I certainly hope so.

SH:      …

CR:      …

SH:      Why are you smiling?

CR:      Your tone of voice. Your sense of humour. I’ve enjoyed this, you know.

SH:      So glad to have been a source of _entertainment_ for you in these past few weeks.

CR:      Not all enjoyment is entertainment, Sherlock. Not all therapy is voyeurism.

SH:      So some of it is, then? Voyeurism?

CR:      What do you think?

SH:      Yes.

CR:      …

SH:      But perhaps not…all.

CR:      I should hope not.

SH:      So what next, then? I wait around here until Monday?

CR:      Yes, that’s the plan. And then you meet with Dr Franklin, to discuss plans for after discharge, referrals, that kind of thing.

SH:      And I won’t see you again.

CR:      Not if all goes well.

SH:      Interesting, that.

CR:      …

SH:      ‘If all goes well.’

CR:      It’s like you said – we have strange incentives for people to get well.

SH:      None at all if you—

CR:      If what?

SH:      Never mind. You were saying: Monday’s plans.

CR:      You’ll meet with Dr Franklin. She’ll go over the discharge papers with you, answer any questions or lingering concerns you still have.

SH:      I don’t have any questions.

CR:      No? Concerns, then?

SH:      Not about my treatment.

CR:      She will still meet with you.

SH:      …

CR:      Anything else?

SH:      I don’t think so. You have, it must be admitted, exceeded my expectations, low though they were.

CR:      Is that a compliment?

SH:      Take it how you will.

CR:      Thank you, Sherlock.

SH:      …

CR:      …

SH:      You shouldn’t thank me. If anyone should be thanking anyone—

CR:      …

SH:      …

CR:      You’re welcome.

SH:      Thank you.

CR:      Yes.

SH:      …

CR:      …

SH:      Good-bye, then.

CR:      Good-bye, Sherlock.


	24. Discharge Summary

**Notes for the Chapter:**

> This is the final chapter of 'In Confidence.' Not surprisingly, it took me longer to write the last two chapters than the others; endings are hard for me, too, especially when I'm working on a story that is as satisfying as this one has been.
> 
> Thank you to everyone who has commented on this work. I have been astounded by the interest in Sherlock and psychopathology and have enjoyed every question you have posed to me and comment that you have left. It has been so, so meaningful to write a story that is based on topics so close to my heart -- psychopathology and healing -- and to engage in so many interesting conversations as a result of it!
> 
> In particular, thank you to roane and shimi for your beta work. And thank you to SherlockScarf for your cover art -- I am honored that you would choose my story to create a cover.
> 
> ~Emma

__________________________________________

From: **Carola Rivas** <rivas@blakely.org.uk>  
Date: Fri, 28 June 2002 at 12:02  
Subject: SH discharge summary

To: **Dr Mariah Franklin** [director@blakely.org.uk](mailto:director@blakely.org.uk)

Mariah:

 I’ve finished the treatment summary for SH and am sending you the draft so you can add your parts to it.

 I’ll be interested to hear how the final meeting with him goes.

 When can you send me your additions?

 ~Carola

____________________________________

From: **Dr Mariah Franklin** [director@blakely.org.uk](mailto:director@blakely.org.uk)  
Date: Monday, 1 July 2002 at 9:33  
Subject: Re: SH discharge summary

To: **Carola Rivas** <rivas@blakely.org.uk>

 

Carola:

 Just met with SH.

 I’ll send you my edits later this afternoon.

 Interesting meeting. He agrees to continue with methadone but said that he doesn’t want to take antidepressants because of sexual SEs. Possible secondary gain from methadone? We should make note of this when we make his London referral. I told him he could choose from Bethlem, Barts, or Maudsley; one of those is sure to meet his exacting standards. Will send out referral notice before the end of the day.

 ~MF

___________________________________

From: **Carola Rivas** <rivas@blakely.org.uk>  
Date: Monday, 1 July 2002 at 11:16

Subject: Re: Re: SH discharge summary

To: **Dr Mariah Franklin** [director@blakely.org.uk](mailto:director@blakely.org.uk)

Mariah:

 According to self-report, his ‘drug of choice’ is cocaine. I am more concerned about him returning to cocaine than about the therapeutic use of opioids. He has told me that he doesn’t want to ‘depend on drugs’ anymore and his compliance to methadone has been appropriate to do. But – he is moving to Edinburgh for the next few months, so we should find a psych hospital to make a referral to there. Do you still have contacts at the Royal Edinburgh?

 ~Carola

__________________________________________

From: **Dr Mariah Franklin** [director@blakely.org.uk](mailto:director@blakely.org.uk)  
Date: Monday, 1 July 2002 at 15:33  
Subject: SH discharge summary attached

To: **Carola Rivas** <rivas@blakely.org.uk>

Carola:

 I know a trauma specialist at Royal E. He might be a good choice for SH. Will add that to the list.

 Attached you will find the discharge summary with my additions. Please review, sign, and leave in my mailbox.

 SH signed consent for his treatment records to be used for training purposes. Please send the therapy tapes to Hugh for transcription.

 Thanks,

Mariah

_____________________________________________________________________________

**Discharge Summary**

**Patient** : Sherlock Holmes

 **Individual psychotherapist:** Carola Rivas, PhD

 **Psychiatrist:** Mariah Franklin, MB BChir, MRCP

 **DOB:** 19.7.1976

 **Age:**  25

 **Date of admission:** 27.5.2002

 **Date of discharge** : 1.7.2002

 

**Reason for Referral**

Mr Holmes was admitted to dual diagnosis unit for detox on 27.5.2002. BIB brother, Mycroft Holmes, following arrest for intoxication on 26.5.2002. Pt was under the influence of cocaine when he was admitted. Mr Holmes had a history of cocaine and opioid dependence and presented with symptoms of a mood disorder, including insomnia, lack of appetite, anhedonia, diminished interest in hobbies and interests, agitation, Global Assessment of Functioning (GAF) 40 at admission. Major impairment in multiple areas: social, occupational, family. Some danger of hurting self or others.

 

**Treatment Received**

Mr Holmes to be discharged Monday, 1 July 2002, following 36 days of residential treatment for cocaine and opioid dependence. Patient attended 14 sessions of individual psychotherapy with Carola Rivas, PhD. He attended 15 sessions of the Social Skills Building Group with Shavani Gupta, PhD. Mr Holmes met with psychiatrist Mariah Franklin on 8 occasions for psychopharmacological management. Methadone therapy began on 30.5.2002 at 30mg/day and was well tolerated by the patient. Methadone was titrated up to 100mg/day by 10.6.2002 without adverse effects. Patient was prescribed continued methadone treatment after discharge and agreed to attend follow-up appointments in London. Referrals were made to methadone clinics at Bethlem, Maudsley, and St Barts in London, and the Royal Edinburgh Hospital in Edinburgh. The psychiatrist discussed with the patient the advantages and disadvantages of prescribing an antidepressant for his symptoms of depression. The patient expressed a concern about the sexual side effects of SSRIs and opted to not begin antidepressants at present.

 

**Treatment Goals and Objectives: Summary**

**1. Goal 1: Pt will reduce dependence on heroin and cocaine. **

  * **Pt will adhere to methadone maintenance therapy as directed by his psychiatrist.** _Patient has achieved this goal. Blood tests and urinanalysis confirm that patient is not using illicit substances and patient is adherent to methadone maintenance therapy._
  * **Pt will identify triggers for substance use.** _Patient is working towards this goal. SH acknowledged that he began to use substances (nicotine) after his mother’s death. Patient acknowledged a relationship between his cocaine use and the initiation of sexual relationships._
  * **Pt will create sobriety plan for after discharge.** _Patient has achieved this goal._ _Patient has expressed the intention to continue receiving methadone treatment in London and has been provided with the appropriate referrals. Patient acknowledges the importance of not returning immediately to environments that he associates with drugs and has arranged to stay with a cousin in Edinburgh for a few months following discharge._
  * **Pt will attend scheduled appointments following discharge**. _Patient has not yet achieved this goal. Patient has not been discharged._



**2. Goal 2: Pt will report fewer mood symptoms. **

  * **Pt will use words to describe his mood state**. _Patient is making progress towards goal. Patient has shown improvement in being able to name and discuss his emotions._
  * **Pt will identify activities that bring him pleasure.** _Patient has achieved this goal. Patient reported enjoying the following activities: reading scientific journals (esp. chemistry, forensics, and psychology); playing the violin; solving crimes; and taking strolls through London._
  * **Pt will engage in pleasurable activities on a daily basis.** _Patient achieved this goal. SH reports playing his violin and reading books and articles on a daily basis, activities which he appears to enjoy._



**3. Goal 3: Staff will report improved social functioning of SH at Blakely House. **

  * **Pt will attend Social Skills Group and adhere to group rules.** _Partial achievement of goal. Pt has shown moderate improvement in behaviour in the Social Skills group. He has participated willingly in group activities such as: letter-writing, sharing of personal histories, and giving compliments to others. After an early altercation with another group member, SH has demonstrated some improvement in his relationships with others. For example, he is able to engage in reciprocal, appropriate conversations with others. However, the pt continues to make inappropriate facial gestures when listening to certain members of the group. He has also been vocal about his dislike of the group and his resentment at having to participate. [Signed Shavani Gupta]_
  * **Pt will obey Blakely House rules regarding behaviour towards others.** _Partial achievement of goal. Patient entered areas that were forbidden to him (ex.: other patients’ rooms, the clinic waiting room) despite repeated admonitions to keep within certain bounds. However, patient followed other clinic rules without incident._
  * **Pt will use psychotherapy to talk about social and family relationships.** _Patient achieved this goal. Patient is well-related to the therapist and showed an increasing willingness to discuss personal issues in therapy, including relationships with his parents, brother, cousin, and romantic partners._



**Narrative Summary of Progress and Recommendation**

A witty and combative conversationalist, Mr Holmes showed initial reluctance to participate in psychotherapy but later appeared to enjoy the therapist’s attention and regard. Over the five weeks that he was in treatment, he made considerable progress in his ability to tolerate painful affective states. He used psychotherapy to talk about incidents of childhood trauma, such as the death of his mother when he was 12yo and being discovered in a sexual act with another boy when he was 11yo. Mr Holmes described the events surrounding his mother’s death in detail, including the reactions from his father and brother, and was able to accept that he had not received the support that he should have received to deal with his grief as a child. Pt harbours resentment towards his older brother for his perceived abandonment of SH following their mother’s death, but appears willing to resume communication with him following discharge. Mr Holmes was able to identify figures who had modelled loving acceptance in his childhood, such as his Spanish grandmother and his female cousin, Georgina, with whom he will be staying once he is discharged. There was mild improvement in the patient’s peripheral neuropathy; however, the patient understands that improvement in symptoms may take several years. He recognizes that further drug use will likely worsen his neuropathy and may lead to permanent impairment in fine motor skills. Mood symptoms continue to affect the patient’s quality-of-life. Mr Holmes meets the following criteria for dysthymia: depressed mood most of the day, for more days than not, for at least two years; and presence of poor appetite, insomnia, low self-esteem, and feelings of hopelessness, not due to the direct physiological effects of a substance, and causing clinically significant distress in social and occupational functioning. It was recommended that Mr Holmes commence antidepressant therapy following discharge; the patient has expressed a preference to not ‘depend on drugs’ once his methadone therapy is terminated. Mr Holmes described his vocational goal of becoming a ‘consulting detective’ and stated an intention to contact the Metropolitan Police of London following discharge in order to apply for a position.  

**Diagnostic Impressions at Termination**

  **Axis I:** Cocaine Withdrawal, Opioid Withdrawal [292.0]; Dysthymic Disorder [300.4]; R/O Asperger's Disorder [299.80]

 **Axis II:** Diagnosis Deferred

 **Axis III:** Peripheral sensory neuropathy [337.1]; Allergies to shellfish, sulfa medications.

 **Axis IV:** Economic problems, housing problems, problems with primary support group, problems related to interaction with the legal system.

 **Axis V:** Global Assessment of Functioning: 55. Moderate difficulty in social and occupational functioning. Moderate mood symptoms.

  ****Signature of Psychologist

Carola Rivas, PhD

1 July 02

  Signature of Psychiatrist

Mariah Franklin, MB BChir, MRCP

1.7.02

 

 

**Works inspired by this one:**

  * [In Confidence - cover art (for emma de los nardos)](https://archiveofourown.org/works/444042) by [SherlocksScarf](https://archiveofourown.org/users/SherlocksScarf/pseuds/SherlocksScarf)




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